Provider Demographics
NPI:1477303220
Name:TRINH, JESSICA T
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:TRINH
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 1:18455 BURBANK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6916
Mailing Address - Country:US
Mailing Address - Phone:818-457-4011
Mailing Address - Fax:
Practice Address - Street 1:18455 BURBANK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6916
Practice Address - Country:US
Practice Address - Phone:818-457-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist