Healthcare Provider Details

I. General information

NPI: 1891149613
Provider Name (Legal Business Name): MARK TREZIA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 101
GLENDALE CA
91204-2563
US

IV. Provider business mailing address

1500 S CENTRAL AVE STE 101
GLENDALE CA
91204-2563
US

V. Phone/Fax

Practice location:
  • Phone: 818-638-9799
  • Fax: 818-638-9697
Mailing address:
  • Phone: 818-638-9799
  • Fax: 818-638-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: