Provider Demographics
NPI:1730226150
Name:TREFRY, GLEN WILLIAM (ATP)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:WILLIAM
Last Name:TREFRY
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1378
Mailing Address - Country:US
Mailing Address - Phone:909-224-9095
Mailing Address - Fax:909-985-9895
Practice Address - Street 1:929 E FOOTHILL BLVD
Practice Address - Street 2:103
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4037
Practice Address - Country:US
Practice Address - Phone:909-224-9095
Practice Address - Fax:909-985-9895
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other