Provider Demographics
NPI:1740900059
Name:TRIDUUM HEALTH CARE LLC
Entity type:Organization
Organization Name:TRIDUUM HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDINWOH
Authorized Official - Middle Name:
Authorized Official - Last Name:OROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:702-292-3578
Mailing Address - Street 1:2301 E SUNSET RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4933
Mailing Address - Country:US
Mailing Address - Phone:725-204-7533
Mailing Address - Fax:725-214-7240
Practice Address - Street 1:2301 E SUNSET RD STE 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4933
Practice Address - Country:US
Practice Address - Phone:725-204-7533
Practice Address - Fax:725-214-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service