Provider Demographics
NPI:1508235268
Name:TREVINO, ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:LOCKUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5220 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3133
Mailing Address - Country:US
Mailing Address - Phone:087-455-2777
Mailing Address - Fax:
Practice Address - Street 1:321 N LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-5622
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant