Provider Demographics
NPI:1184229833
Name:TRAVIESO, TRILCE (RPH)
Entity type:Individual
Prefix:
First Name:TRILCE
Middle Name:
Last Name:TRAVIESO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15835 SW 68TH TER APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3600
Mailing Address - Country:US
Mailing Address - Phone:786-312-3687
Mailing Address - Fax:
Practice Address - Street 1:11402 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4859
Practice Address - Country:US
Practice Address - Phone:305-599-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist