Provider Demographics
NPI:1629111919
Name:INGRID E TRENKLE MD INC
Entity Type:Organization
Organization Name:INGRID E TRENKLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRENKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-335-2018
Mailing Address - Street 1:124 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5250
Mailing Address - Country:US
Mailing Address - Phone:909-335-2018
Mailing Address - Fax:909-335-1641
Practice Address - Street 1:124 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5250
Practice Address - Country:US
Practice Address - Phone:909-335-2018
Practice Address - Fax:909-335-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27162207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89443Medicare UPIN