Provider Demographics
NPI:1962951699
Name:TRIVINO, MARIA INES (LAC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:INES
Last Name:TRIVINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4263
Mailing Address - Country:US
Mailing Address - Phone:732-898-0471
Mailing Address - Fax:732-898-0463
Practice Address - Street 1:180 TICES LN. BLDG A. STE 203
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1345
Practice Address - Country:US
Practice Address - Phone:732-898-0471
Practice Address - Fax:732-898-0463
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2017-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005721171100000X
NJ25MZ00120800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist