Organization
THE TRIDENT PACIFIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENDA MORENO (OFFICE MANAGER)
(318) 212-3740
Entity
Organization
Contact information
Practice address
8001 YOUREE DR STE 550, SHREVEPORT, LA 71115-2325
(318) 212-3740
Mailing address
PO BOX 5455, SHREVEPORT, LA 71135-5455
(318) 212-3740
(318) 212-3758
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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