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General NPI Number Information
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NPI Number | 1306468020
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Entity Type | Organization
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Legal Business Name | TREVEDAN, INC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 34778 HICKORY LN
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City | WILDOMAR
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State | CA
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Zip | 92595-8990
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Country | US
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Telephone | 562-552-4210
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Fax | 310-356-3886
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Provider Business Mailing Address
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Address Line | 34778 HICKORY LN
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City | WILDOMAR
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State | CA
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Zip | 92595-8990
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Country | US
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Telephone | 562-552-4210
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Fax | 310-356-3886
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. LARRY M CARTER
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Credential |
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Telephone | 562-552-4210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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