Basic Information
Provider Information
NPI: 1003299439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FEWINS
FirstName: TREVOR
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 849 HANLON WAY
Address2:  
City: BENICIA
State: CA
PostalCode: 945103672
CountryCode: US
TelephoneNumber: 7073342205
FaxNumber:  
Practice Location
Address1: 3838 CALIFORNIA ST
Address2: SUITE 715
City: SAN FRANCISCO
State: CA
PostalCode: 941181522
CountryCode: US
TelephoneNumber: 4155922017
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2015
LastUpdateDate: 07/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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