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General NPI Number Information
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NPI Number | 1700618790
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Entity Type | Individual
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Provider Name | TRENTEN JAMES DIPPOLD PA
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Gender | Male
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Dates
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Enumeration Date | 08/17/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1300 N 12TH ST STE 500
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City | PHOENIX
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State | AZ
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Zip | 85006-2849
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Country | US
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Telephone | 602-839-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 555 N COLLEGE AVE APT 4047
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City | TEMPE
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State | AZ
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Zip | 85288-0222
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Country | US
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Telephone | 814-706-5074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10657
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License Number State | AZ
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