Provider Demographics
NPI:1235167305
Name:TREISTER, NEIL W (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:W
Last Name:TREISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:25405 HANCOCK AVE
Mailing Address - Street 2:STE 216
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-698-4600
Mailing Address - Fax:951-514-2542
Practice Address - Street 1:5256 S MISSION RD
Practice Address - Street 2:SUITE 802
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-3614
Practice Address - Country:US
Practice Address - Phone:951-698-4600
Practice Address - Fax:951-514-2542
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
CAG451030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G451030Medicaid
CA00G451030Medicare PIN
CAB57525Medicare UPIN
CA00G451030Medicaid
CAWG45102CMedicare PIN
CA060043106Medicare PIN