Provider Demographics
NPI:1639387350
Name:TRIVINO, CHRISTOPHER ANTHONY (IDC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ANTHONY
Last Name:TRIVINO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 ARMFIELD CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3217
Mailing Address - Country:US
Mailing Address - Phone:757-472-8071
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE
Practice Address - Street 2:BLDG.H NAVY MEDICINE SUPPORT COMMAND, ATTN: MSSD
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:757-472-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman