Provider Demographics
NPI:1174904411
Name:TREVINO-RIVAS, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:TREVINO-RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 EUBANK BLVD SE
Mailing Address - Street 2:BLDG 831
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3453
Mailing Address - Country:US
Mailing Address - Phone:505-284-0429
Mailing Address - Fax:
Practice Address - Street 1:1515 EUBANK BLVD SE
Practice Address - Street 2:BLDG 831
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3453
Practice Address - Country:US
Practice Address - Phone:505-284-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy