Healthcare Provider Details

I. General information

NPI: 1396172359
Provider Name (Legal Business Name): PATRICIA ANTONETTE TROMBLY CNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISH TROMBLY CNC

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 JALISCO PL
DAVIS CA
95616-0232
US

IV. Provider business mailing address

214 JALISCO PL
DAVIS CA
95616-0232
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-2237
  • Fax:
Mailing address:
  • Phone: 530-753-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: