Basic Information
| Provider Information | |||||||||
| NPI: | 1881222800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDILLO | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | KENT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 W PRIVE CIR | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334453846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046443865 | ||||||||
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| Practice Location | |||||||||
| Address1: | 703 N FLAMINGO RD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330281006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548441404 | ||||||||
| FaxNumber: | 9542760404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2020 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.