Provider Demographics
NPI:1154642619
Name:TREVINO, AMANDA LEE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SANTA ROSA
Mailing Address - Street 2:CENTER FOR CHILDREN & FAMILIES, SUITE 4703
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-2575
Mailing Address - Fax:210-704-2545
Practice Address - Street 1:333 N SANTA ROSA
Practice Address - Street 2:CENTER FOR CHILDREN & FAMILES, 4TH FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4140
Practice Address - Fax:210-704-4136
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0038082390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program