Individual
LARA TREVINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
304 W 88TH ST, 3D, NEW YORK, NY 10024-2227
(214) 864-4882
Mailing address
85 W BURNSIDE AVE, BRONX, NY 10453-4015
(718) 716-4400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
691374-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F307592-1
NY
Other
Enumeration date
03/02/2015
Last updated
03/28/2016
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