Provider Demographics
NPI:1770086852
Name:TREVINO, RICHARD
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
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 1:402 W WHEATLAND RD STE 170A
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4629
Mailing Address - Country:US
Mailing Address - Phone:469-999-1003
Mailing Address - Fax:469-283-8127
Practice Address - Street 1:402 W WHEATLAND RD STE 170A
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4629
Practice Address - Country:US
Practice Address - Phone:469-999-1003
Practice Address - Fax:469-283-8127
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)