Provider Demographics
NPI:1205208501
Name:TREVIZO, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:TREVIZO
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 1:6845 DONIPHAN DR STE B
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-5048
Mailing Address - Country:US
Mailing Address - Phone:915-222-5635
Mailing Address - Fax:
Practice Address - Street 1:6845 DONIPHAN
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835
Practice Address - Country:US
Practice Address - Phone:915-222-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program