Provider Demographics
NPI:1114937992
Name:TRIVEDI, ROHIT R (MD)
Entity Type:Individual
Prefix:
First Name:ROHIT
Middle Name:R
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E ARTESIA ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2900
Mailing Address - Country:US
Mailing Address - Phone:909-865-1161
Mailing Address - Fax:909-865-1737
Practice Address - Street 1:160 E ARTESIA ST
Practice Address - Street 2:SUITE 355
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2900
Practice Address - Country:US
Practice Address - Phone:909-865-1161
Practice Address - Fax:909-865-1737
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37268174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00A372680Medicaid
CA330001800OtherRAILROAD PROVIDER
CAWA37268AMedicare ID - Type Unspecified
CO00A372680Medicaid