Organization
JOSE DE JESUS TREVINO PAIN MANAGEMENT CENTER P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE DE JESUS TREVINO M.D. (OWNER)
(361) 883-1744
Entity
Organization
Contact information
Practice address
613 ELIZABETH ST, SUITE 805, CORPUS CHRISTI, TX 78404-2220
(361) 883-1744
(361) 882-3920
Mailing address
PO BOX 3905, CORPUS CHRISTI, TX 78463-3905
(361) 883-1744
(361) 882-3920
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
F-2074
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017DR
BLUE CROSS BLUE SHIELD
TX
05
—
133638001
—
TX
01
—
C22769
UPIN
TX
Enumeration date
09/30/2008
Last updated
01/20/2009
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