Basic Information
| Provider Information | |||||||||
| NPI: | 1780110742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIGUEROS | ||||||||
| FirstName: | CRISTIAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2370 CORPORATE CIR STE 300 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029103950 | ||||||||
| FaxNumber: | 7027866650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 E CALVADA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890483906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752108333 | ||||||||
| FaxNumber: | 7753469158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA2373 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1780110742 | 05 | NV | MEDICAID | PA2373 | 01 | NV | STATE LICENSE | OTHER |