Healthcare Provider Details

I. General information

NPI: 1821700030
Provider Name (Legal Business Name): TRINITY KIA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD STE 350
CARLSBAD CA
92011-1451
US

IV. Provider business mailing address

130 LAS FLORES DR
SAN MARCOS CA
92069-6001
US

V. Phone/Fax

Practice location:
  • Phone: 760-438-0078
  • Fax:
Mailing address:
  • Phone: 669-258-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0206552385
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: