Provider Demographics
NPI:1760350516
Name:TREVATHAN, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:TREVATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 E MEATS AVE TRLR 173
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-4020
Mailing Address - Country:US
Mailing Address - Phone:951-923-8060
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6470
Practice Address - Country:US
Practice Address - Phone:714-584-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist