Provider Demographics
NPI:1366629024
Name:CESAR D TRIVINO MD PA
Entity Type:Organization
Organization Name:CESAR D TRIVINO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TRIVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-275-9064
Mailing Address - Street 1:304 LOMA LINDA LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-8500
Mailing Address - Country:US
Mailing Address - Phone:806-275-9064
Mailing Address - Fax:
Practice Address - Street 1:200 S MCGEE ST
Practice Address - Street 2:ANESTHESIA SUITE
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4022
Practice Address - Country:US
Practice Address - Phone:806-275-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5592207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078KQOtherBCBS
TX1629230-01Medicaid
TX0078KQOtherBCBS