Provider Demographics
NPI:1003057142
Name:TRIM, SANDRA PATRICIA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:PATRICIA
Last Name:TRIM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1728
Mailing Address - Country:US
Mailing Address - Phone:310-751-1118
Mailing Address - Fax:310-397-4417
Practice Address - Street 1:2048 W 69 ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047
Practice Address - Country:US
Practice Address - Phone:310-571-1118
Practice Address - Fax:310-397-4417
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191952164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse