Provider Demographics
NPI:1427744010
Name:NEPOMUCENO, TRISHA CAMILLE A
Entity type:Individual
Prefix:
First Name:TRISHA CAMILLE
Middle Name:A
Last Name:NEPOMUCENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2016
Mailing Address - Country:US
Mailing Address - Phone:818-633-0708
Mailing Address - Fax:
Practice Address - Street 1:10418 HANNA AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2016
Practice Address - Country:US
Practice Address - Phone:818-633-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner