Provider Demographics
NPI:1821818436
Name:TREVINO, MANUEL JAMES
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JAMES
Last Name:TREVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 N 85TH AVE # 926
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6520
Mailing Address - Country:US
Mailing Address - Phone:480-670-9442
Mailing Address - Fax:
Practice Address - Street 1:10700 N 85TH AVE # 926
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6520
Practice Address - Country:US
Practice Address - Phone:480-670-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy