Provider Demographics
NPI:1518579218
Name:TREVINO, GABRAIEL ARTURO (LAT)
Entity Type:Individual
Prefix:
First Name:GABRAIEL
Middle Name:ARTURO
Last Name:TREVINO
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3317
Mailing Address - Country:US
Mailing Address - Phone:937-405-9453
Mailing Address - Fax:
Practice Address - Street 1:12500 MERANDA RD
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9604
Practice Address - Country:US
Practice Address - Phone:937-498-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0043552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer