Provider Demographics
NPI:1073256301
Name:TREVINO, VICTORIA RAE
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:RAE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 LOCKHILL SELMA RD APT 123
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1508
Mailing Address - Country:US
Mailing Address - Phone:830-719-2224
Mailing Address - Fax:
Practice Address - Street 1:1835 LOCKHILL SELMA RD APT 123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1508
Practice Address - Country:US
Practice Address - Phone:830-719-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer