Provider Demographics
NPI:1891802799
Name:TREVINO, SAN JUANITA ZOILA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SAN JUANITA
Middle Name:ZOILA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E VEGA LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6428
Mailing Address - Country:US
Mailing Address - Phone:512-627-1374
Mailing Address - Fax:
Practice Address - Street 1:411 E VEGA LN
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6428
Practice Address - Country:US
Practice Address - Phone:512-972-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ53231Medicare UPIN
TX8G0189Medicare ID - Type Unspecified