Provider Demographics
NPI:1932751716
Name:HUNTLEY, TREVOR LEONARD (LAC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEONARD
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MENKER AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2450
Mailing Address - Country:US
Mailing Address - Phone:669-300-9752
Mailing Address - Fax:
Practice Address - Street 1:16270 MONTEREY RD
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7166
Practice Address - Country:US
Practice Address - Phone:408-710-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18134171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist