Provider Demographics
NPI:1366883639
Name:IGLESIAS, TRIXIA-MARIE CARBONELL (RN)
Entity type:Individual
Prefix:
First Name:TRIXIA-MARIE
Middle Name:CARBONELL
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26226 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2922
Mailing Address - Country:US
Mailing Address - Phone:510-491-3802
Mailing Address - Fax:
Practice Address - Street 1:26226 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2922
Practice Address - Country:US
Practice Address - Phone:510-491-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse