Provider Demographics
NPI:1407041809
Name:TREVINO, PABLO (DPM)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 POLARIS
Mailing Address - Street 2:SUITE A 1
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-4725
Mailing Address - Country:US
Mailing Address - Phone:956-718-0075
Mailing Address - Fax:956-718-0086
Practice Address - Street 1:6419 POLARIS
Practice Address - Street 2:SUITE A 1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-4725
Practice Address - Country:US
Practice Address - Phone:956-718-0075
Practice Address - Fax:956-718-0086
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005288213ES0103X
TX1856213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery