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General NPI Number Information
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NPI Number | 1093861346
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Entity Type | Individual
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Provider Name | TREVER BIVONA M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 1600 DIVISADERO STREET, 4TH FLOOR BOX 1674
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-353-7160
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 DIVISADERO STREET, 4TH FLOOR, BOX 1674
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-353-7160
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Fax |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | A119835
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 242984
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License Number State | NY
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