Provider Demographics
NPI:1629342993
Name:TRINA HEALTH, LLC
Entity Type:Organization
Organization Name:TRINA HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACTING SPECIALIS
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROEDIGER DE BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-226-3736
Mailing Address - Street 1:5112 BAILEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2519
Mailing Address - Country:US
Mailing Address - Phone:916-550-1050
Mailing Address - Fax:
Practice Address - Street 1:4441 AUBURN BLVD
Practice Address - Street 2:J
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-550-1050
Practice Address - Fax:916-550-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33983OtherLICENCE