Provider Demographics
NPI:1255803003
Name:LLANES, TRISHA RIMANDO (BSN, RN)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:RIMANDO
Last Name:LLANES
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 GOFF CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7864
Mailing Address - Country:US
Mailing Address - Phone:619-479-8645
Mailing Address - Fax:
Practice Address - Street 1:1445 GOFF CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7864
Practice Address - Country:US
Practice Address - Phone:619-479-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse