Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 20679 | TX |
NPI | 1811027428 |
---|---|
Provider Name | Dr. Cesar Trevino |
First Address | Laredo, TX 78041-5305 |
Second Address | Laredo, TX 78041-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151777302 | (05) | TX |
U90647 | (02) | TX |