=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104644012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIFECTA MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2024
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7702 MEANY AVE STE 101
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-843-7830
-----------------------------------------------------
Fax | 559-223-9907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7702 MEANY AVE STE 101
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-843-7830
-----------------------------------------------------
Fax | 559-223-9907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. VALERIE CIVELLI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 850-206-9553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------