Healthcare Provider Details

I. General information

NPI: 1396107231
Provider Name (Legal Business Name): CAROLINA TRIVINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-9990
US

IV. Provider business mailing address

1515 SW ARCHER RD
GAINESVILLE FL
32608-9990
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-265-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT 86867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: