Provider Demographics
NPI:1407576093
Name:ILUMIN, TRISHA (PA)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:ILUMIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-679-3590
Mailing Address - Fax:
Practice Address - Street 1:1508 ALHAMBRA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6510
Practice Address - Country:US
Practice Address - Phone:916-679-3590
Practice Address - Fax:916-669-4100
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2024-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA64448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant