Healthcare Provider Details

I. General information

NPI: 1487594297
Provider Name (Legal Business Name): TREVOR WATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N. MARIO CAPECCHI DR, HELIX BLDG. LEVEL 2 SOUTH, SLC
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N. MARIO CAPECCHI, HELIX BLDG, LEVEL 2 SOUTH
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: