Provider Demographics
NPI:1457435489
Name:JAVIER TREVINO
Entity Type:Organization
Organization Name:JAVIER TREVINO
Other - Org Name:LIBERTY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:SR
Authorized Official - Credentials:RRT
Authorized Official - Phone:956-631-7406
Mailing Address - Street 1:1349 E HACKBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5702
Mailing Address - Country:US
Mailing Address - Phone:956-631-7406
Mailing Address - Fax:956-631-7506
Practice Address - Street 1:1349 E HACKBERRY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5702
Practice Address - Country:US
Practice Address - Phone:956-631-7406
Practice Address - Fax:956-631-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58015332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188084101Medicaid
TX188084102Medicaid
TX188084101Medicaid