Healthcare Provider Details

I. General information

NPI: 1336915875
Provider Name (Legal Business Name): TRINITY GARNETTE YELLOWROBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINITY GARNETTE YELLOWROBE-LEE

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WHISPERING WIND DR STE 110
TRACY CA
95377-8119
US

IV. Provider business mailing address

510 WHISPERING WIND DR STE 110
TRACY CA
95377-8119
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-7756
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax: 209-832-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: