1487328316 NPI number — DR. MATTHEW LORENZO TRINIDAD DC

Table of content: DR. MATTHEW LORENZO TRINIDAD DC (NPI 1487328316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487328316 NPI number — DR. MATTHEW LORENZO TRINIDAD DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRINIDAD
Provider First Name:
MATTHEW
Provider Middle Name:
LORENZO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487328316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46368-9230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-763-8112
Provider Business Mailing Address Fax Number:
219-764-5333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1828 165TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46320-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-763-8112
Provider Business Practice Location Address Fax Number:
219-764-5333
Provider Enumeration Date:
08/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08003217A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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