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NPI Code Detail

MEDICARE: TRINA WIGGINS MD

MEDICARE: TRINA WIGGINS MD
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
1208000000XPediatrics Physician8386NV

Other Identifiers

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

General Provider Information

NPI Number : 1568816056
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRINA WIGGINS MD
Provider Business Mailing Address
First Line : 1240 N MARTIN LUTHER KING BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2825
Country : US
Telephone Number : 702-967-0530
Fax Number :
Provider Business Practice Location Address
First Line : 1240 N MARTIN LUTHER KING BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2825
Country : US
Telephone Number : 702-967-0530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2016
Last Update Date : 08/09/2016

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