Provider Demographics
NPI:1366448243
Name:PAUL L TREGER MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAUL L TREGER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:TREGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-460-9077
Mailing Address - Street 1:7877 PARKWAY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2000
Mailing Address - Country:US
Mailing Address - Phone:619-460-9077
Mailing Address - Fax:619-460-2184
Practice Address - Street 1:7877 PARKWAY DR
Practice Address - Street 2:STE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2000
Practice Address - Country:US
Practice Address - Phone:619-460-9077
Practice Address - Fax:619-460-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26803207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00GR68030Medicaid
CA3846220002Medicare NSC
A43103Medicare UPIN
CA00GR68030Medicaid
CA3846220001Medicare NSC