Active NPI
Jennifer Laurel Trevino, LD RDN
- Registered Dietitian
- Las Vegas, NV
National Provider Identifier
1700390341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 39307-DI-0
- Practice address
- 4215 S Grand Canyon Dr Ste 101
Las Vegas, NV 89147-7173 - Phone
- (702) 664-1204
- NPI assigned
- Nov 17, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 39307-DI-0 | NV | Primary |
Addresses
Primary practice location
4215 S Grand Canyon Dr Ste 101
Las Vegas, NV 89147-7173
Mailing address
4215 S Grand Canyon Dr Ste 101
Las Vegas, NV 89147-7173
Phone (702) 664-1204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39307-DI-0 | NV | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510876800000",
"number": "1700390341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4215 S GRAND CANYON DR STE 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891477173",
"telephone_number": "702-664-1204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4215 S GRAND CANYON DR STE 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891477173",
"telephone_number": "702-664-1204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREVINO",
"first_name": "JENNIFER",
"middle_name": "LAUREL",
"credential": "LD RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-17",
"last_updated": "2017-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "NV",
"license": "39307-DI-0",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.