Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G30668 | CA |
NPI | 1003987082 |
---|---|
Provider Name | Robert M. Trevino |
First Address | Santa Barbara, CA 93160-2106 |
Second Address | Lompoc, CA 93436-7000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G306680 | (05) | CA |
A44506 | (02) |