Provider Demographics
NPI:1447898689
Name:TRIGNO, ANDRE VINSENSIUS (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:VINSENSIUS
Last Name:TRIGNO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 RAINTREE PL
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3649
Mailing Address - Country:US
Mailing Address - Phone:909-272-6607
Mailing Address - Fax:
Practice Address - Street 1:1101 S MILLIKEN AVE STE C
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8112
Practice Address - Country:US
Practice Address - Phone:909-390-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist