Provider Demographics
NPI:1619995651
Name:TRIANGLE THERAPEUTICS
Entity Type:Organization
Organization Name:TRIANGLE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORIBIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:409-982-8878
Mailing Address - Street 1:5957 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6204
Mailing Address - Country:US
Mailing Address - Phone:409-982-8878
Mailing Address - Fax:409-982-5119
Practice Address - Street 1:5957 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6204
Practice Address - Country:US
Practice Address - Phone:409-982-8878
Practice Address - Fax:409-982-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042HVOtherBLUE CROSS BLUE SHIELD
TX200793800OtherTRICARE
TX0042HVOtherBLUE CROSS BLUE SHIELD