Provider Demographics
NPI:1467758235
Name:PRESTIGE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESNUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-217-3334
Mailing Address - Street 1:1000 NEWBURY RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6435
Mailing Address - Country:US
Mailing Address - Phone:805-214-3122
Mailing Address - Fax:805-214-3129
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:STE. 130
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-214-3122
Practice Address - Fax:805-214-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty