Provider Demographics
NPI:1639811748
Name:TREVINO, ADRIAN ELISEO MAR
Entity Type:Individual
Prefix:
First Name:ADRIAN ELISEO
Middle Name:MAR
Last Name:TREVINO
Suffix:
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 1:3751 E 14TH ST SUITE 111
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-801-2278
Mailing Address - Fax:956-594-4219
Practice Address - Street 1:3193 W ALTON GLOOR BLVD STE M
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3509
Practice Address - Country:US
Practice Address - Phone:956-801-2278
Practice Address - Fax:956-594-4219
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX021230374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty