Provider Demographics
NPI:1437431251
Name:TRIGUENO, MAXI R (LPN)
Entity Type:Individual
Prefix:
First Name:MAXI
Middle Name:R
Last Name:TRIGUENO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 ALABAMA AVE
Mailing Address - Street 2:4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5246
Mailing Address - Country:US
Mailing Address - Phone:347-262-6447
Mailing Address - Fax:347-787-4133
Practice Address - Street 1:475 ALABAMA AVE
Practice Address - Street 2:4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5246
Practice Address - Country:US
Practice Address - Phone:347-262-6447
Practice Address - Fax:347-787-4133
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse