Provider Demographics
NPI:1063818615
Name:TRINIDAD, DANTE
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:TRINIDAD
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 1:1030 BROADWAY
Mailing Address - Street 2:APT 134
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7809
Mailing Address - Country:US
Mailing Address - Phone:760-473-4989
Mailing Address - Fax:
Practice Address - Street 1:1030 BROADWAY
Practice Address - Street 2:APT 134
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7809
Practice Address - Country:US
Practice Address - Phone:760-473-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN839393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse