Provider Demographics
NPI:1184800427
Name:TRINITY HEART
Entity type:Organization
Organization Name:TRINITY HEART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ODDETH
Authorized Official - Middle Name:NAJAH
Authorized Official - Last Name:AFARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-593-7855
Mailing Address - Street 1:514 JAMACHA RD
Mailing Address - Street 2:UNIT 13J
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2483
Mailing Address - Country:US
Mailing Address - Phone:619-328-2521
Mailing Address - Fax:
Practice Address - Street 1:1331 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5811
Practice Address - Country:US
Practice Address - Phone:619-593-7855
Practice Address - Fax:619-240-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6068600001Medicare NSC