Provider Demographics
NPI:1346242393
Name:TREVINO, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13750 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4375
Mailing Address - Country:US
Mailing Address - Phone:210-561-3100
Mailing Address - Fax:210-545-3076
Practice Address - Street 1:123 STONE OAK LOOP
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3391
Practice Address - Country:US
Practice Address - Phone:210-495-7334
Practice Address - Fax:210-495-7203
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120531205Medicaid
TX120531205Medicaid