Healthcare Provider Details

I. General information

NPI: 1457133738
Provider Name (Legal Business Name): TREVOR M DOLLING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 COTTAGE AVE
MANTECA CA
95336-4942
US

IV. Provider business mailing address

3827 N 10TH ST STE 305
MCALLEN TX
78501-1745
US

V. Phone/Fax

Practice location:
  • Phone: 209-624-7006
  • Fax: 209-554-4601
Mailing address:
  • Phone: 956-803-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: