MEDICARE: MARIA THI TRINH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	22563	CA

General Provider Information

NPI Number	:	1023369667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA THI TRINH PA-C

Provider Business Mailing Address
First Line	:	724 E MERCED AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-5142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	473 N FAIR OAKS AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3621
Country	:	US
Telephone Number	:	626-792-2378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2012
Last Update Date	:	04/17/2016

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