Healthcare Provider Details

I. General information

NPI: 1881912848
Provider Name (Legal Business Name): TRINITY HEALTHCARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SOLANO ST
CORNING CA
96021-3511
US

IV. Provider business mailing address

145 SOLANO ST
CORNING CA
96021-3511
US

V. Phone/Fax

Practice location:
  • Phone: 530-824-5401
  • Fax: 530-824-1188
Mailing address:
  • Phone: 530-824-5401
  • Fax: 530-824-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA19505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number363069
License Number StateCA

VIII. Authorized Official

Name: DR. SANDRA LEE BAGWELL
Title or Position: PRESIDENT
Credential: PHD, FNP-C
Phone: 530-824-5401