Provider Demographics
NPI:1699568576
Name:BALLENTINE, TRINA MONIQUE (ARRT, ARDMS, NTQR)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:MONIQUE
Last Name:BALLENTINE
Suffix:
Gender:X
Credentials:ARRT, ARDMS, NTQR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 COUNTRY MILE RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6626
Mailing Address - Country:US
Mailing Address - Phone:626-756-7679
Mailing Address - Fax:
Practice Address - Street 1:1515 W CAMERON AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2734
Practice Address - Country:US
Practice Address - Phone:626-756-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP260152471S1302X
CA10343062471S1302X
CA2689432471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty