MEDICARE: RENISSE TRECIA TRILLANA PA

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	363A00000X	Physician Assistant	AMD-1129	HI
2	363A00000X	Physician Assistant	PA61342922	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073978359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENISSE TRECIA TRILLANA PA

Provider Business Mailing Address
First Line	:	590 FARRINGTON HWY UNIT 525
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2034
Country	:	US
Telephone Number	:	808-762-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 FARRINGTON HWY UNIT 525
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2034
Country	:	US
Telephone Number	:	808-762-2311
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	01/06/2026

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