Provider Demographics
NPI:1710656053
Name:TREVINO, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-1675
Mailing Address - Country:US
Mailing Address - Phone:254-753-2226
Mailing Address - Fax:254-753-2233
Practice Address - Street 1:3801 N 19TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1675
Practice Address - Country:US
Practice Address - Phone:254-753-2226
Practice Address - Fax:254-753-2233
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician