Provider Demographics
NPI:1891577318
Name:SCHULTZ, TREVOR NORMAN
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:NORMAN
Last Name:SCHULTZ
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 1:492 GROVE ST # 11
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4303
Mailing Address - Country:US
Mailing Address - Phone:646-645-6915
Mailing Address - Fax:
Practice Address - Street 1:492 GROVE ST # 11
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4303
Practice Address - Country:US
Practice Address - Phone:646-645-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2024-01-17
Deactivation Date:2023-10-25
Deactivation Code:
Reactivation Date:2024-01-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program