Basic Information
| Provider Information | |||||||||
| NPI: | 1689048357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TREVINO | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TREVINO | ||||||||
| OtherFirstName: | EDDY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2529 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787045466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789500 | ||||||||
| FaxNumber: | 5129789558 | ||||||||
| Practice Location | |||||||||
| Address1: | 2529 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787045466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789500 | ||||||||
| FaxNumber: | 5129789558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2015 | ||||||||
| LastUpdateDate: | 03/07/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT84164 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 86044483 | TX | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.