Provider Demographics
NPI:1376630558
Name:KUCERA, TRISHA L
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:KUCERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 E RED RIVER ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5628
Mailing Address - Country:US
Mailing Address - Phone:361-578-3772
Mailing Address - Fax:361-578-3217
Practice Address - Street 1:2002 E RED RIVER ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5628
Practice Address - Country:US
Practice Address - Phone:361-578-3772
Practice Address - Fax:361-578-3217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX532112OtherBC/BS