Healthcare Provider Details

I. General information

NPI: 1235843624
Provider Name (Legal Business Name): NISHEA TRINIDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 POTTLE AVE
FRESNO CA
93706-3755
US

IV. Provider business mailing address

714 POTTLE AVE
FRESNO CA
93706-3755
US

V. Phone/Fax

Practice location:
  • Phone: 408-656-2525
  • Fax:
Mailing address:
  • Phone: 408-656-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: