Provider Demographics
NPI:1457911828
Name:STONE, MARK TREVER X
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TREVER
Last Name:STONE
Suffix:X
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 1:19873 EMMETT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4801
Mailing Address - Country:US
Mailing Address - Phone:661-251-9917
Mailing Address - Fax:
Practice Address - Street 1:19873 EMMETT RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-4801
Practice Address - Country:US
Practice Address - Phone:661-251-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified