Provider Demographics
NPI:1811531585
Name:TRIMBLE, CARLOS DELGADO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:DELGADO
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:ELDER
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1651 E NICKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-2469
Mailing Address - Country:US
Mailing Address - Phone:269-983-5833
Mailing Address - Fax:
Practice Address - Street 1:1651 E NICKERSON AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2469
Practice Address - Country:US
Practice Address - Phone:269-983-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician