Provider Demographics
NPI:1932685591
Name:TREVINO, MARIELA (LVN)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5464
Mailing Address - Country:US
Mailing Address - Phone:956-630-1116
Mailing Address - Fax:
Practice Address - Street 1:2103 MILE 3 RD
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-2032
Practice Address - Country:US
Practice Address - Phone:656-617-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335245164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse