Provider Demographics
NPI:1376968800
Name:TREVINO, RUBEN
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:BAYVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78566
Mailing Address - Country:US
Mailing Address - Phone:956-592-7100
Mailing Address - Fax:956-544-7728
Practice Address - Street 1:835 N EXPRESSWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6831
Practice Address - Country:US
Practice Address - Phone:956-544-7722
Practice Address - Fax:956-544-7728
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21423OtherSOCIAL WORKER LICENSE