Provider Demographics
NPI:1003981242
Name:TREVINO, LUCINA B (MD)
Entity type:Individual
Prefix:
First Name:LUCINA
Middle Name:B
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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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
Mailing Address - Country:US
Mailing Address - Phone:210-433-3334
Mailing Address - Fax:210-932-2570
Practice Address - Street 1:505 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1335
Practice Address - Country:US
Practice Address - Phone:210-932-2565
Practice Address - Fax:210-932-2566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102511605Medicaid
TX102511605Medicaid
G15384Medicare UPIN