Provider Demographics
NPI:1437853645
Name:FLATIN, TREVOR ALAN
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALAN
Last Name:FLATIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3908
Mailing Address - Country:US
Mailing Address - Phone:818-554-0776
Mailing Address - Fax:
Practice Address - Street 1:3460 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1538
Practice Address - Country:US
Practice Address - Phone:818-945-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist