Healthcare Provider Details

I. General information

NPI: 1104780659
Provider Name (Legal Business Name): TRINA HARRIS CAMBRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 GENTILLY BLVD
NEW ORLEANS LA
70122-3808
US

IV. Provider business mailing address

3028 GENTILLY BLVD
NEW ORLEANS LA
70122-3808
US

V. Phone/Fax

Practice location:
  • Phone: 504-948-6080
  • Fax:
Mailing address:
  • Phone: 504-948-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number251S00000X
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: