Provider Demographics
NPI:1467984971
Name:TRINA HEALTH OF NEWPORT BEACH PC
Entity Type:Organization
Organization Name:TRINA HEALTH OF NEWPORT BEACH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-550-1050
Mailing Address - Street 1:1525 SUPERIOR AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3639
Mailing Address - Country:US
Mailing Address - Phone:949-722-7902
Mailing Address - Fax:949-772-7903
Practice Address - Street 1:1525 SUPERIOR AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3639
Practice Address - Country:US
Practice Address - Phone:949-722-7902
Practice Address - Fax:949-772-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty