Provider Demographics
NPI:1689705493
Name:TRAMBLE, TERRY ALLAN
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ALLAN
Last Name:TRAMBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:ALLAN
Other - Last Name:TRAMBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:5018 VALLEYDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1019
Mailing Address - Country:US
Mailing Address - Phone:213-639-2680
Mailing Address - Fax:213-380-6434
Practice Address - Street 1:255 S MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5407
Practice Address - Country:US
Practice Address - Phone:213-639-2680
Practice Address - Fax:213-480-6434
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator