Provider Demographics
NPI:1740486208
Name:HECTOR R. TREVINO, M.D., P.A.
Entity type:Organization
Organization Name:HECTOR R. TREVINO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-773-3353
Mailing Address - Street 1:2176 E GARRISON ST STE C
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5072
Mailing Address - Country:US
Mailing Address - Phone:830-773-3353
Mailing Address - Fax:
Practice Address - Street 1:2176 E GARRISON ST STE C
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5072
Practice Address - Country:US
Practice Address - Phone:830-773-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159627201Medicaid
TX159627201Medicaid
TXH02188Medicare UPIN