Provider Demographics
NPI:1306833249
Name:TREVINO, ROBERT P (DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:TREVINO
Suffix:
Gender:M
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 S SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1226
Mailing Address - Country:US
Mailing Address - Phone:210-533-8886
Mailing Address - Fax:
Practice Address - Street 1:1302 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1226
Practice Address - Country:US
Practice Address - Phone:210-533-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130846203Medicaid
83040BMedicare ID - Type Unspecified
C22770Medicare UPIN