Provider Demographics
NPI:1801452792
Name:TRIANA-JACOME, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:TRIANA-JACOME
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 1:8347 116TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3467
Mailing Address - Country:US
Mailing Address - Phone:347-785-5811
Mailing Address - Fax:
Practice Address - Street 1:8347 116TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3467
Practice Address - Country:US
Practice Address - Phone:347-785-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY742260039-00Medicaid