Healthcare Provider Details

I. General information

NPI: 1114913761
Provider Name (Legal Business Name): ROBERT GRINNELL TRENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 CHURN CREEK RD
REDDING CA
96002-2122
US

IV. Provider business mailing address

3190 CHURN CREEK RD
REDDING CA
96002-2122
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2500
  • Fax: 530-226-1375
Mailing address:
  • Phone: 530-223-2500
  • Fax: 530-226-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG86708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: