Provider Demographics
NPI:1780110742
Name:TRIGUEROS, CRISTIAN (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:TRIGUEROS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-786-6650
Practice Address - Street 1:1470 E CALVADA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3906
Practice Address - Country:US
Practice Address - Phone:775-210-8333
Practice Address - Fax:775-346-9158
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2373363A00000X, 363AM0700X
CA54424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780110742Medicaid
NVPA2373OtherSTATE LICENSE