Provider Demographics
NPI:1386397792
Name:RICHARDS, TREVER (MLS, CLS)
Entity type:Individual
Prefix:
First Name:TREVER
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MLS, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 W FIGARDEN DR APT 247
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8619
Mailing Address - Country:US
Mailing Address - Phone:661-213-6950
Mailing Address - Fax:
Practice Address - Street 1:2491 ALLUVIAL AVE STE 35
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-9587
Practice Address - Country:US
Practice Address - Phone:661-213-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA-02047004246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist