Provider Demographics
NPI:1942215710
Name:SCANLAN, TRIEVA KARIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRIEVA
Middle Name:KARIN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRIEVA
Other - Middle Name:KARIN
Other - Last Name:TURANCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:MAIL DROP 4S-205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-827-7450
Mailing Address - Fax:
Practice Address - Street 1:2176 SALK AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7346
Practice Address - Country:US
Practice Address - Phone:760-827-7450
Practice Address - Fax:760-827-7425
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A846930Medicaid
CA00A846930Medicaid
CAI30696Medicare UPIN