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General NPI Number Information
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NPI Number | 1962951699
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Entity Type | Individual
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Provider Name | MARIA INES TRIVINO L.AC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 11/23/2017
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Provider Practice Location Address
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Address Line | 180 TICES LN. BLDG A. STE 203
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1345
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Country | US
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Telephone | 732-898-0471
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Fax | 732-898-0463
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Provider Business Mailing Address
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Address Line | 71 CANTERBURY RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4263
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Country | US
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Telephone | 732-898-0471
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Fax | 732-898-0463
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005721
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00120800
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License Number State | NJ
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