Provider Demographics
NPI:1851999064
Name:TREVINO, CRISTINA (ST)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 SEVE LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7605
Mailing Address - Country:US
Mailing Address - Phone:956-740-2966
Mailing Address - Fax:
Practice Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 1&2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4769
Practice Address - Country:US
Practice Address - Phone:956-753-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist