Provider Demographics
NPI:1356449425
Name:HENDERSON, TREVOR HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:HOWARD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4800
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5244
Practice Address - Country:US
Practice Address - Phone:619-265-3400
Practice Address - Fax:619-265-3407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-04-07
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Provider Licenses
StateLicense IDTaxonomies
CAA65341208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356449425Medicaid