Basic Information
| Provider Information | |||||||||
| NPI: | 1164699344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROFIMENKO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 632 W GIBSON RD | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306682600 | ||||||||
| FaxNumber: | 5306612410 | ||||||||
| Practice Location | |||||||||
| Address1: | 632 W GIBSON RD | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306682600 | ||||||||
| FaxNumber: | 5306612410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2008 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA19189 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.