Healthcare Provider Details

I. General information

NPI: 1356594022
Provider Name (Legal Business Name): TRINA S GOMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINA S BINGHAM

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S 20TH AVE
SAFFORD AZ
85546-4052
US

IV. Provider business mailing address

2110 W CACTUS RD
SAFFORD AZ
85546-8400
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-2151
  • Fax:
Mailing address:
  • Phone: 928-348-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN152502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: