Provider Demographics
NPI:1639315989
Name:TREVINO, PETER PAUL (MBA, BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:PAUL
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MBA, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10449 TRAILWAY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-5514
Mailing Address - Country:US
Mailing Address - Phone:210-379-9716
Mailing Address - Fax:
Practice Address - Street 1:10449 TRAILWAY OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5514
Practice Address - Country:US
Practice Address - Phone:210-379-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse