Healthcare Provider Details

I. General information

NPI: 1487383253
Provider Name (Legal Business Name): JAY TRINIDAD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOSS ST
CHULA VISTA CA
91911-2005
US

IV. Provider business mailing address

286 BONITA CANYON DR
BONITA CA
91902-4280
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-4221
  • Fax:
Mailing address:
  • Phone: 619-482-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95166577
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95166577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: