Provider Demographics
NPI:1710970884
Name:TOMLINSON-CHESNUT, TREISE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:TREISE
Middle Name:NICOLE
Last Name:TOMLINSON-CHESNUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TREISE
Other - Middle Name:NICOLE
Other - Last Name:CHESNUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 NEWBURY ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-214-3122
Mailing Address - Fax:805-214-3129
Practice Address - Street 1:1000 NEWBURY ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-214-3122
Practice Address - Fax:805-214-3129
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FC912ZOtherMEDICARE PTAN
FC912ZOtherMEDICARE PTAN