Healthcare Provider Details

I. General information

NPI: 1801114566
Provider Name (Legal Business Name): STELLA TREBONIK PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 IMPERIAL HWY
LA MIRADA CA
90638-2512
US

IV. Provider business mailing address

15800 IMPERIAL HWY
LA MIRADA CA
90638-2512
US

V. Phone/Fax

Practice location:
  • Phone: 562-902-5538
  • Fax: 562-902-6517
Mailing address:
  • Phone: 562-902-5538
  • Fax: 562-902-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: