Provider Demographics
NPI:1023356730
Name:TRESTLES PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:TRESTLES PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-650-9401
Mailing Address - Street 1:33171 PASEO CERVEZA
Mailing Address - Street 2:207
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-4870
Mailing Address - Country:US
Mailing Address - Phone:310-650-9401
Mailing Address - Fax:949-388-1759
Practice Address - Street 1:33171 PASEO CERVEZA
Practice Address - Street 2:207
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4870
Practice Address - Country:US
Practice Address - Phone:310-650-9401
Practice Address - Fax:949-388-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site