MEDICARE: ROBERT TRIFUNOVIC

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	207V00000X	Obstetrics & Gynecology Physician	G65362	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G653620	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700820305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT TRIFUNOVIC

Provider Business Mailing Address
First Line	:	488 E. VALLEY PARKWAY
Second Line	:	SUITE 311
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 E. VALLEY PARKWAY
Second Line	:	SUITE 311
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3373
Country	:	US
Telephone Number	:	760-233-1896
Fax Number	:	760-233-1899

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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