Provider Demographics
NPI:1093475303
Name:TRISTYN ST THOMAS-ACHOJA, MD, INC, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TRISTYN ST THOMAS-ACHOJA, MD, INC, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISTYN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ST. THOMAS-ACHOJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-588-2190
Mailing Address - Street 1:5 HOLLAND
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:1741 W ROMNEYA DR
Practice Address - Street 2:SUITE F
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1805
Practice Address - Country:US
Practice Address - Phone:714-408-9481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty