Provider Demographics
NPI:1538533104
Name:TREVINO, DARA DANIELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DARA
Middle Name:DANIELLE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DARA
Other - Middle Name:DANIELLE
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20642 STONE OAK PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7363
Mailing Address - Country:US
Mailing Address - Phone:210-650-0814
Mailing Address - Fax:210-650-0926
Practice Address - Street 1:20642 STONE OAK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7363
Practice Address - Country:US
Practice Address - Phone:210-650-0814
Practice Address - Fax:210-650-0926
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10112363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant