Healthcare Provider Details

I. General information

NPI: 1497782429
Provider Name (Legal Business Name): TREVOR ADAM WINTON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24156 BIG TIMBER ST
LAKE FOREST CA
92630-2919
US

IV. Provider business mailing address

24156 BIG TIMBER ST
LAKE FOREST CA
92630-2919
US

V. Phone/Fax

Practice location:
  • Phone: 949-283-9592
  • Fax: 949-380-9748
Mailing address:
  • Phone: 949-283-9592
  • Fax: 949-380-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: