MEDICARE: AILEEN VERA-TRINER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach		TX
2	136A00000X	Registered Dietetic Technician	86265104	TX

General Provider Information

NPI Number	:	1568159853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN VERA-TRINER

Provider Business Mailing Address
First Line	:	4309 CRENSHAW AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-4233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 CRENSHAW AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-4233
Country	:	US
Telephone Number	:	217-799-9418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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Directions to “ AILEEN VERA-TRINER ” Practice Location

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