Provider Demographics
NPI:1740368554
Name:TREMAYNE, PAULA S (DO)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:TREMAYNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8495208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A84952OtherMCARE PTAN
CA00AX84950Medicaid
CA00AX84950Medicaid
CAZZZ18851ZMedicare PIN