=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730987140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERA TROFIMENKO, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 N BROADWAY
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-984-6640
-----------------------------------------------------
Fax | 714-984-6604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 N BROADWAY
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-984-6640
-----------------------------------------------------
Fax | 714-984-6604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VERA TROFIMENKO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-984-6640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------