Healthcare Provider Details

I. General information

NPI: 1003290677
Provider Name (Legal Business Name): TREVOR AXELROD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W. PUEBLO STREET, MEDICAL EDUCATION OFFICE SANTA BARBARA COTTAGE HOSPITAL
SANTA BARBARA CA
93105
US

IV. Provider business mailing address

PO BOX 208599
DALLAS TX
75320-8599
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-7315
  • Fax: 805-569-8358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number64938
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number64938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: