Provider Demographics
NPI:1861787418
Name:TRINIDAD, JAKE JULIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:JULIAN
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:14603 HUEBNER RD BLDG 12
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5481
Mailing Address - Country:US
Mailing Address - Phone:210-774-1109
Mailing Address - Fax:
Practice Address - Street 1:14603 HUEBNER RD BLDG 12
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5481
Practice Address - Country:US
Practice Address - Phone:210-774-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1861787418OtherNPI
TX1700528239OtherNPI