Provider Demographics
NPI:1043622269
Name:TRERRA, TAIRU
Entity Type:Individual
Prefix:
First Name:TAIRU
Middle Name:
Last Name:TRERRA
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 1:1296 SHERIDAN AVE APT 3I
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1399
Mailing Address - Country:US
Mailing Address - Phone:646-546-1431
Mailing Address - Fax:
Practice Address - Street 1:1296 SHERIDAN AVE APT 3I
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1399
Practice Address - Country:US
Practice Address - Phone:646-546-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318466164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse