Provider Demographics
NPI:1417313560
Name:MEDICAL EXAMINER
Entity Type:Organization
Organization Name:MEDICAL EXAMINER
Other - Org Name:TRENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRAVEL PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-463-1578
Mailing Address - Street 1:464 LUCE AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5631
Mailing Address - Country:US
Mailing Address - Phone:707-463-1578
Mailing Address - Fax:
Practice Address - Street 1:464 LUCE AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5631
Practice Address - Country:US
Practice Address - Phone:707-463-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty