Provider Demographics
NPI:1780076539
Name:TREVINO, ROGELIO JR (ABOC)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:TREVINO
Suffix:JR
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41975 MARGARITA RD
Mailing Address - Street 2:#145
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2868
Mailing Address - Country:US
Mailing Address - Phone:951-250-8091
Mailing Address - Fax:
Practice Address - Street 1:41975 MARGARITA RD
Practice Address - Street 2:#145
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-2868
Practice Address - Country:US
Practice Address - Phone:951-250-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169153156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician