Provider Demographics
NPI:1205446945
Name:LAXAMANA, TRISHA DOMANTAY (MD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:DOMANTAY
Last Name:LAXAMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0002
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:507-284-0702
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2025-05-12
Deactivation Date:2021-10-20
Deactivation Code:
Reactivation Date:2022-02-21
Provider Licenses
StateLicense IDTaxonomies
MN79360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine