Individual
JESSICA MARIE TREVINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9211 WATERFORD CENTRE BLVD, #200, AUSTIN, TX 78758-7667
(512) 420-0186
(512) 420-0397
Mailing address
9211 WATERFORD CENTRE BLVD, #200, AUSTIN, TX 78758-7667
(512) 420-0186
(512) 420-0397
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TEMPORARY
TX
207RG0100X
Gastroenterology Physician
Primary
M3769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
317657003
—
TX
Enumeration date
06/06/2006
Last updated
11/14/2013
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