Provider Demographics
NPI:1710038625
Name:TREVINO, SYLVIA B (PA-C)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:B
Last Name:TREVINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831026
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-1026
Mailing Address - Country:US
Mailing Address - Phone:210-433-3334
Mailing Address - Fax:210-932-2570
Practice Address - Street 1:507 PLEASANTON RD
Practice Address - Street 2:SUITE #101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1335
Practice Address - Country:US
Practice Address - Phone:210-433-3334
Practice Address - Fax:210-932-2570
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S44002Medicare UPIN