Basic Information
| Provider Information | |||||||||
| NPI: | 1477745685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIX | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JUDSON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, RN, APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 TREAT BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522828 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 122 LA CASA VIA STE 120 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259414058 | ||||||||
| FaxNumber: | 9259414049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2007 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 17156 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.