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NPI Code Detail

MEDICARE: TREVON LOCKWOOD

MEDICARE:   TREVON  LOCKWOOD
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1881222891
Entity Type Code : Individual
Provider Name (Legal Business Name) : TREVON LOCKWOOD
Provider Business Mailing Address
First Line : 1213 ALVARADO AVE APT 12
Second Line :
City : DAVIS
State : CA
Zip : 95616-5942
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1446 ETHAN WAY STE 100
Second Line :
City : SACRAMENTO
State : CA
Zip : 95825-2235
Country : US
Telephone Number : 209-345-7353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 03/27/2020

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Directions to “ TREVON LOCKWOOD ” Practice Location

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