Healthcare Provider Details

I. General information

NPI: 1437088945
Provider Name (Legal Business Name): TREVER NACHIMZON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JENSEN CT
THOUSAND OAKS CA
91360-7483
US

IV. Provider business mailing address

979 TRIUNFO CANYON RD
WESTLAKE VILLAGE CA
91361-1826
US

V. Phone/Fax

Practice location:
  • Phone: 805-444-0771
  • Fax:
Mailing address:
  • Phone: 805-413-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: