Provider Demographics
NPI:1073616025
Name:TROLAN, THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:
Last Name:TROLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SOQUEL DR
Mailing Address - Street 2:STE 330
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1719
Mailing Address - Country:US
Mailing Address - Phone:831-465-7761
Mailing Address - Fax:831-475-1156
Practice Address - Street 1:1820 41ST AVE STE D
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2516
Practice Address - Country:US
Practice Address - Phone:831-476-3000
Practice Address - Fax:831-476-9009
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61013208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610130OtherMEDI-CAL ID NUMBER
CA00G610130OtherMEDI-CAL ID NUMBER