Provider Demographics
NPI:1215546486
Name:TRAPP, BENNIE
Entity Type:Individual
Prefix:
First Name:BENNIE
Middle Name:
Last Name:TRAPP
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 1:12860 PERRIS BLVD APT D7
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4168
Mailing Address - Country:US
Mailing Address - Phone:951-536-0251
Mailing Address - Fax:
Practice Address - Street 1:12860 PERRIS BLVD APT D7
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4168
Practice Address - Country:US
Practice Address - Phone:951-536-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider