Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A143154 | CA |
NPI | 1134549066 |
---|---|
Provider Name | Dr. Trevor Shelton |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 16/09/2020 |