Provider Demographics
NPI:1922251735
Name:HOLLOWAY, TREVOR MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:MICHAEL
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 YORBA LINDA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4052
Mailing Address - Country:US
Mailing Address - Phone:714-577-6000
Mailing Address - Fax:714-223-1864
Practice Address - Street 1:18300 YORBA LINDA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4052
Practice Address - Country:US
Practice Address - Phone:714-577-6000
Practice Address - Fax:714-223-1864
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF456ZMedicare PIN