Provider Demographics
NPI:1922484682
Name:TRAMEL, TRAVIS (RDHAP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:TRAMEL
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 FLAT ROCK DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7115
Mailing Address - Country:US
Mailing Address - Phone:951-428-1714
Mailing Address - Fax:
Practice Address - Street 1:4199 FLAT ROCK DR
Practice Address - Street 2:SUITE 127
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7115
Practice Address - Country:US
Practice Address - Phone:951-428-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist