Healthcare Provider Details

I. General information

NPI: 1629342993
Provider Name (Legal Business Name): TRINA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 AUBURN BLVD J
SACRAMENTO CA
95841
US

IV. Provider business mailing address

5112 BAILEY LOOP
MCCLELLAN CA
95652-2519
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-1050
  • Fax: 916-550-1238
Mailing address:
  • Phone: 916-550-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: FAITH A ROEDIGER DE BONILLA
Title or Position: CREDENTIALING/CONTRACTING SPECIALIS
Credential:
Phone: 916-226-3736