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NPI Code Detail

MEDICARE: TREVOR EUGENE FOSTER JR AMFT

MEDICARE: TREVOR EUGENE FOSTER JR AMFT
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1689009102
Entity Type Code : Individual
Provider Name (Legal Business Name) : TREVOR EUGENE FOSTER JR AMFT
Provider Business Mailing Address
First Line : 15473 MARTOS RD
Second Line :
City : FONTANA
State : CA
Zip : 92337-9055
Country : US
Telephone Number : 909-260-9023
Fax Number :
Provider Business Practice Location Address
First Line : 390 N EUCLID AVE
Second Line :
City : UPLAND
State : CA
Zip : 91786-4763
Country : US
Telephone Number : 909-949-7740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2013
Last Update Date : 06/13/2024

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