Provider Demographics
NPI:1023690153
Name:TREVIZO, SANDY (DO)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:TREVIZO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 INTERSTATE 30 STE 200
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2633
Mailing Address - Country:US
Mailing Address - Phone:972-216-5400
Mailing Address - Fax:972-216-5405
Practice Address - Street 1:3228 INTERSTATE 30 STE 200
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2633
Practice Address - Country:US
Practice Address - Phone:972-216-5400
Practice Address - Fax:972-216-5405
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine