Healthcare Provider Details

I. General information

NPI: 1013202365
Provider Name (Legal Business Name): TRIXY SYU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 WHIPPLE RD
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

12815 HEACOCK ST
MORENO VALLEY CA
92553-3116
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-4807
  • Fax:
Mailing address:
  • Phone: 951-353-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A13977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: