Healthcare Provider Details

I. General information

NPI: 1235167305
Provider Name (Legal Business Name): NEIL W. TREISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 S MISSION RD SUITE 802
BONSALL CA
92003-3614
US

IV. Provider business mailing address

25405 HANCOCK AVE STE 216
MURRIETA CA
92562
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4600
  • Fax: 951-514-2542
Mailing address:
  • Phone: 951-698-4600
  • Fax: 951-514-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG451030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: