Provider Demographics
NPI:1922234210
Name:RADASA, TRINETTE L (ACNS, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:TRINETTE
Middle Name:L
Last Name:RADASA
Suffix:
Gender:F
Credentials:ACNS, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1334
Mailing Address - Country:US
Mailing Address - Phone:575-639-0139
Mailing Address - Fax:
Practice Address - Street 1:2489 LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1334
Practice Address - Country:US
Practice Address - Phone:575-639-0139
Practice Address - Fax:619-324-4188
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01898363LF0000X
OR10023195363LP0808X
NMR44432364SA2200X
CA95010084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1201473OtherCAQH ID