Provider Demographics
NPI:1164891461
Name:BLITT, TRINITY AZEVEDO (AUD)
Entity Type:Individual
Prefix:DR
First Name:TRINITY
Middle Name:AZEVEDO
Last Name:BLITT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:TRINITY
Other - Middle Name:
Other - Last Name:AZEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:237 TRIUMPH LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2053
Mailing Address - Country:US
Mailing Address - Phone:209-756-8456
Mailing Address - Fax:
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-759-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3077231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist