MEDICARE: DR. JAKE JULIAN TRINIDAD M.D.

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	207W00000X	Ophthalmology Physician	Q5111	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861787418	OTHER	TX	NPI
2	1700528239	OTHER	TX	NPI

General Provider Information

NPI Number	:	1861787418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAKE JULIAN TRINIDAD M.D.

Provider Business Mailing Address
First Line	:	14603 HUEBNER RD BLDG 12
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5481
Country	:	US
Telephone Number	:	210-774-1109
Fax Number	:

Provider Business Practice Location Address
First Line	:	14603 HUEBNER RD BLDG 12
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5481
Country	:	US
Telephone Number	:	210-774-1109
Fax Number	:

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

Provider Enumeration Date	:	06/11/2011
Last Update Date	:	09/20/2022

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