Provider Demographics
NPI:1992211189
Name:SOUTHERLAND, TRINA FELICIA (RN)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:FELICIA
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15920 POMONA RINCON RD UNIT 6703
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5535
Mailing Address - Country:US
Mailing Address - Phone:404-490-7675
Mailing Address - Fax:323-580-0320
Practice Address - Street 1:8549 WILSHIRE BLVD # 2262
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3104
Practice Address - Country:US
Practice Address - Phone:840-200-3963
Practice Address - Fax:323-580-0320
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95239757163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty