MEDICARE: MR. TREVOR ADAM WINTON ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1497782429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR ADAM WINTON ATC

Provider Business Mailing Address
First Line	:	24156 BIG TIMBER ST
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2919
Country	:	US
Telephone Number	:	949-283-9592
Fax Number	:	949-380-9748

Provider Business Practice Location Address
First Line	:	24156 BIG TIMBER ST
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-2919
Country	:	US
Telephone Number	:	949-283-9592
Fax Number	:	949-380-9748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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