Provider Demographics
NPI:1609979145
Name:TROMBELLO, KARLA ANN (DPM)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:ANN
Last Name:TROMBELLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-577-3682
Mailing Address - Fax:360-577-1871
Practice Address - Street 1:1114 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-577-3682
Practice Address - Fax:360-577-1871
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8247942Medicaid
U74613Medicare UPIN
WAG8800163Medicare ID - Type Unspecified