Provider Demographics
NPI:1841814209
Name:TREVINO, HUMBERTO JR (MD)
Entity type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:TREVINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 ROWLAND WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5054
Mailing Address - Country:US
Mailing Address - Phone:415-897-9664
Mailing Address - Fax:415-892-9589
Practice Address - Street 1:75 ROWLAND WAY STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5054
Practice Address - Country:US
Practice Address - Phone:415-897-9664
Practice Address - Fax:415-892-9589
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071463207Q00000X
ORMD217900207Q00000X
CAA198049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine