Provider Demographics
NPI:1972786796
Name:AMMAR, TRINA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:AMMAR
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:TRAVINA
Other - Middle Name:CYNTHIA
Other - Last Name:BUTLER-AMMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1120 FOREST AVE # 181
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5105
Mailing Address - Country:US
Mailing Address - Phone:831-229-1114
Mailing Address - Fax:
Practice Address - Street 1:1120 FOREST AVE # 181
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5105
Practice Address - Country:US
Practice Address - Phone:831-229-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193-11069163WL0100X
CARN442767163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant