Provider Demographics
NPI:1598345134
Name:TREVINO, VICTOR ALBERT JR
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALBERT
Last Name:TREVINO
Suffix:JR
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 1:1621 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4564
Mailing Address - Country:US
Mailing Address - Phone:281-599-0958
Mailing Address - Fax:281-599-7515
Practice Address - Street 1:1621 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4564
Practice Address - Country:US
Practice Address - Phone:281-599-0958
Practice Address - Fax:281-599-7515
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100472183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician