Provider Demographics
NPI:1689048357
Name:TREVINO, EDUARDO (RD)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:EDDY
Other - Middle Name:
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2529 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5466
Mailing Address - Country:US
Mailing Address - Phone:512-978-9500
Mailing Address - Fax:512-978-9558
Practice Address - Street 1:2529 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5466
Practice Address - Country:US
Practice Address - Phone:512-978-9500
Practice Address - Fax:512-978-9558
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84164133V00000X
TX86044483133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered