Provider Demographics
NPI:1326423922
Name:GOZALI, TRISNA (NP-C)
Entity Type:Individual
Prefix:
First Name:TRISNA
Middle Name:
Last Name:GOZALI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ALTA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1113 ALTA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2800
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily