Individual
DR. RODOLFO ANIBAL TRIVISONNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
319 119TH DRIVE SE, LAKE STEVENS, WA 98258-7717
(425) 948-7893
(425) 948-7943
Mailing address
PO BOX 160, LAKE STEVENS, WA 98258-7717
(425) 252-9216
(425) 252-8637
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00034739
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202833
LABOR AND INDUSTRIES
WA
01
—
4890RT
REGENCE
WA
01
—
553011
VALUE OPTION
WA
05
—
8214850
—
WA
Enumeration date
01/03/2007
Last updated
01/09/2024
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