Provider Demographics
NPI:1376752576
Name:RICARDO S TREVINO
Entity Type:Organization
Organization Name:RICARDO S TREVINO
Other - Org Name:NUESTRA GENTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-753-6493
Mailing Address - Street 1:1212 N MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5350
Mailing Address - Country:US
Mailing Address - Phone:956-753-6493
Mailing Address - Fax:956-712-0016
Practice Address - Street 1:1212 N MEADOW AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5350
Practice Address - Country:US
Practice Address - Phone:956-753-6493
Practice Address - Fax:956-712-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116310261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001896OtherDAHS
TX116310OtherSTATE LICENSE