Provider Demographics
NPI:1962552810
Name:TRINQUE COURCHESNE, MARIE CHANTAL SONIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE CHANTAL
Middle Name:SONIA
Last Name:TRINQUE COURCHESNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE CHANTAL
Other - Middle Name:SONIA
Other - Last Name:TRINQUE COURCHESNE RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:984 MONUMENT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3859
Mailing Address - Country:US
Mailing Address - Phone:310-459-0800
Mailing Address - Fax:
Practice Address - Street 1:984 MONUMENT ST STE 203
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3859
Practice Address - Country:US
Practice Address - Phone:310-459-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-71915207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH47684Medicare UPIN