Provider Demographics
NPI:1578614236
Name:TREVINO, FAVIOLA H (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAVIOLA
Middle Name:H
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3262
Mailing Address - Country:US
Mailing Address - Phone:956-661-9494
Mailing Address - Fax:956-661-9495
Practice Address - Street 1:1701 DOVE AVE.
Practice Address - Street 2:STE. D
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-661-9494
Practice Address - Fax:956-661-9495
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist