Healthcare Provider Details

I. General information

NPI: 1629346630
Provider Name (Legal Business Name): PAULA TREMAYNE, D.O., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COFFEE RD SUITE D
MODESTO CA
95355-4241
US

IV. Provider business mailing address

817 COFFEE RD SUITE D
MODESTO CA
95355-4241
US

V. Phone/Fax

Practice location:
  • Phone: 209-549-1600
  • Fax: 209-549-1601
Mailing address:
  • Phone: 209-549-1600
  • Fax: 209-549-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20A8495
License Number StateCA

VIII. Authorized Official

Name: DR. PAULA TREMAYNE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 209-549-1600