Provider Demographics
NPI:1649400847
Name:TRINITY ENT AND FACIAL AESTHETICS, LLC
Entity Type:Organization
Organization Name:TRINITY ENT AND FACIAL AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-558-3223
Mailing Address - Street 1:3485 S MERCY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0429
Mailing Address - Country:US
Mailing Address - Phone:480-558-3223
Mailing Address - Fax:480-558-5152
Practice Address - Street 1:3485 S MERCY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0429
Practice Address - Country:US
Practice Address - Phone:480-558-3223
Practice Address - Fax:480-558-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34172207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212627Medicaid