Provider Demographics
NPI:1942180120
Name:TREVINO, BLANCA A (LMT)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:A
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N MCCOLL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2205
Mailing Address - Country:US
Mailing Address - Phone:956-706-0971
Mailing Address - Fax:
Practice Address - Street 1:5200 N MCCOLL RD STE 4
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2205
Practice Address - Country:US
Practice Address - Phone:956-706-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty