Healthcare Provider Details

I. General information

NPI: 1407576093
Provider Name (Legal Business Name): TRISHA ILUMIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 EUREKA RD
ROSEVILLE CA
95661-3085
US

IV. Provider business mailing address

1504 EUREKA RD STE 150
ROSEVILLE CA
95661-3111
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-8696
  • Fax: 916-453-8715
Mailing address:
  • Phone: 916-453-8696
  • Fax: 916-453-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number64448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: