Healthcare Provider Details

I. General information

NPI: 1710225396
Provider Name (Legal Business Name): MONICA G TRINIDAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18965 GOLD HILL DR
WALNUT CA
91789-4107
US

IV. Provider business mailing address

18965 GOLD HILL DR
WALNUT CA
91789-4107
US

V. Phone/Fax

Practice location:
  • Phone: 626-964-5077
  • Fax: 626-964-5077
Mailing address:
  • Phone: 626-964-5077
  • Fax: 626-964-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: