Provider Demographics
NPI:1588914311
Name:TREVINO, JUAN RAMON (RD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:RAMON
Last Name:TREVINO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 SPRINGFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3282
Mailing Address - Country:US
Mailing Address - Phone:956-712-9988
Mailing Address - Fax:956-791-4888
Practice Address - Street 1:5711 SPRINGFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3282
Practice Address - Country:US
Practice Address - Phone:956-712-9988
Practice Address - Fax:956-791-4888
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered