MEDICARE: ELIJAH TRIF

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	163W00000X	Registered Nurse	237889	AZ

General Provider Information

NPI Number	:	1821607086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH TRIF

Provider Business Mailing Address
First Line	:	5705 W LUDDEN MOUNTAIN DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2750
Country	:	US
Telephone Number	:	623-505-8631
Fax Number	:

Provider Business Practice Location Address
First Line	:	5705 W LUDDEN MOUNTAIN DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2750
Country	:	US
Telephone Number	:	623-505-8631
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	11/27/2023

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Directions to “ ELIJAH TRIF ” Practice Location

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