Provider Demographics
NPI:1932408044
Name:TREVINO, JORGE ORLANDO (RT ARRT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ORLANDO
Last Name:TREVINO
Suffix:
Gender:M
Credentials:RT ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1615 E LOEB ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-0627
Mailing Address - Country:US
Mailing Address - Phone:956-878-9296
Mailing Address - Fax:956-661-8005
Practice Address - Street 1:4425 N MCCOLL RD STE 11
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2464
Practice Address - Country:US
Practice Address - Phone:956-878-9296
Practice Address - Fax:956-661-8005
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX23843247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351917OtherAMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGIST
TX23843OtherCERTIFIED MEDICAL RADIOLOGIC TECHNOLOGIST