Provider Demographics
NPI:1902695919
Name:TRIANA, JACQUELINE BEATRICE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BEATRICE
Last Name:TRIANA
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BEATRICE
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1256 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6026
Mailing Address - Country:US
Mailing Address - Phone:575-525-8713
Mailing Address - Fax:
Practice Address - Street 1:1256 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6026
Practice Address - Country:US
Practice Address - Phone:575-525-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00010042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist