Healthcare Provider Details

I. General information

NPI: 1992159271
Provider Name (Legal Business Name): MARIA DANIELA TRIVINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E OSCEOLA PKWY
KISSIMMEE FL
34744-1607
US

IV. Provider business mailing address

9605 CAPENDON AVE APT. 301
PALM BEACH GARDENS FL
33418-7714
US

V. Phone/Fax

Practice location:
  • Phone: 407-720-4651
  • Fax: 407-720-4690
Mailing address:
  • Phone: 305-924-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: