Provider Demographics
NPI:1568241669
Name:TRIBALIGHTS TT LLC
Entity Type:Organization
Organization Name:TRIBALIGHTS TT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER & COO
Authorized Official - Prefix:
Authorized Official - First Name:PHOENIX
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-721-4398
Mailing Address - Street 1:20548 VENTURA BLVD # 10-407
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 ROAD 2050
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-3004
Practice Address - Country:US
Practice Address - Phone:310-721-4398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health