MEDICARE: TRINA FELICIA SOUTHERLAND RN

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	95239757	CA

General Provider Information

NPI Number	:	1992211189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA FELICIA SOUTHERLAND RN

Provider Business Mailing Address
First Line	:	15920 POMONA RINCON RD UNIT 6703
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5535
Country	:	US
Telephone Number	:	404-490-7675
Fax Number	:	323-580-0320

Provider Business Practice Location Address
First Line	:	8549 WILSHIRE BLVD # 2262
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3104
Country	:	US
Telephone Number	:	840-200-3963
Fax Number	:	323-580-0320

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

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	05/09/2024

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