Provider Demographics
NPI:1477302743
Name:HULL, TREVOR VINCENT
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:VINCENT
Last Name:HULL
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 1:10971 HUBER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6346
Mailing Address - Country:US
Mailing Address - Phone:714-492-9378
Mailing Address - Fax:
Practice Address - Street 1:1202 W CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2252
Practice Address - Country:US
Practice Address - Phone:714-245-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker