Provider Demographics
NPI:1669199881
Name:TRINITY INTEGRATIVE MEDICAL SPECIALISTS INC.
Entity type:Organization
Organization Name:TRINITY INTEGRATIVE MEDICAL SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDRANEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-501-4252
Mailing Address - Street 1:44274 GEORGE CUSHMAN CT STE 208
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5945
Mailing Address - Country:US
Mailing Address - Phone:951-501-4252
Mailing Address - Fax:951-610-0297
Practice Address - Street 1:44274 GEORGE CUSHMAN CT STE 208
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-501-4252
Practice Address - Fax:951-610-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty