Healthcare Provider Details

I. General information

NPI: 1285503888
Provider Name (Legal Business Name): MARY CRUS TRINIDAD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CRUS OCHOA RDH

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17897 MACARTHUR BLVD STE 100
IRVINE CA
92614-0532
US

IV. Provider business mailing address

3894 BROTHERTON ST
CORONA CA
92879-1809
US

V. Phone/Fax

Practice location:
  • Phone: 949-251-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number34559
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH9123
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: