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General NPI Number Information
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NPI Number | 1063490092
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Entity Type | Individual
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Provider Name | TREVYN LLOYD DESPAIN RPT
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 3908 10TH ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3522
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Country | US
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Telephone | 951-274-7744
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Fax | 951-274-7754
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Provider Business Mailing Address
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Address Line | 1128 ALEXIS LN
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City | REDLANDS
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State | CA
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Zip | 92374-1839
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Country | US
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Telephone | 909-335-6395
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Fax | 951-274-7754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24715
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License Number State | CA
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