Provider Demographics
NPI:1497247449
Name:TRINIDAD, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 N LITCHFIELD RD BLDG 1130
Mailing Address - Street 2:
Mailing Address - City:LUKE AIR FORCE BASE
Mailing Address - State:AZ
Mailing Address - Zip Code:85309-1529
Mailing Address - Country:US
Mailing Address - Phone:623-856-2296
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD BLDG 1130
Practice Address - Street 2:
Practice Address - City:LUKE AIR FORCE BASE
Practice Address - State:AZ
Practice Address - Zip Code:85309-1529
Practice Address - Country:US
Practice Address - Phone:623-856-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program