Provider Demographics
NPI:1720779127
Name:PANIAGUA, TRISHA JANE
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:JANE
Last Name:PANIAGUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 N MILLS AVE # 302
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:909-319-9371
Mailing Address - Fax:
Practice Address - Street 1:1401 N EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4983
Practice Address - Country:US
Practice Address - Phone:909-319-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025222363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health