Provider Demographics
NPI:1720239718
Name:TREVINO, ANGELICA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MORELOS AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9514
Mailing Address - Country:US
Mailing Address - Phone:956-455-3754
Mailing Address - Fax:
Practice Address - Street 1:5337 S PADRE ISLD HWY STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4409
Practice Address - Country:US
Practice Address - Phone:956-831-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8T7819OtherBCBS PROVIDER