Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101018732 | VA |
N | 208200000X | Surgeon | 0101018732 | VA |
N | 208600000X | Surgeon | 0101018732 | VA |
NPI | 1023038825 |
---|---|
Provider Name | Dr. Juan Alberto Trinidad |
First Address | Reston, VA 20190-3215 |
Second Address | Reston, VA 20190-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7332939 | (05) | VA |
B06984 | (02) | VA |