Healthcare Provider Details

I. General information

NPI: 1902600893
Provider Name (Legal Business Name): TREVOR JASEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 MOTOR AVE STE 110
LOS ANGELES CA
90034-3766
US

IV. Provider business mailing address

236 BAY ST APT 9
SANTA MONICA CA
90405-1073
US

V. Phone/Fax

Practice location:
  • Phone: 424-672-6700
  • Fax:
Mailing address:
  • Phone: 973-295-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: