Provider Demographics
NPI:1376513119
Name:TREWELLA, AMY C (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:C
Last Name:TREWELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:TREWELLA - VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:277 RANCHEROS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2959
Mailing Address - Country:US
Mailing Address - Phone:760-291-6700
Mailing Address - Fax:760-471-0513
Practice Address - Street 1:277 RANCHEROS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2959
Practice Address - Country:US
Practice Address - Phone:760-291-6700
Practice Address - Fax:760-471-0513
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
CAA99176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 99176OtherMEDICAL LICENSE
CAGG379ZOtherMEDICARE PTAN