Provider Demographics
NPI:1629346630
Name:PAULA TREMAYNE, D.O., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAULA TREMAYNE, D.O., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:TREMAYNE CENTER FOR MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-549-1600
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
Mailing Address - Country:US
Mailing Address - Phone:209-549-1600
Mailing Address - Fax:209-549-1601
Practice Address - Street 1:817 COFFEE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-549-1600
Practice Address - Fax:209-549-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8495207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A84952OtherMCARE PTAN
CA00AX84950Medicaid
CAZZZ18851ZMedicare PIN
CAI22253Medicare UPIN