Healthcare Provider Details

I. General information

NPI: 1740368554
Provider Name (Legal Business Name): PAULA S. TREMAYNE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/05/2016
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 TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A8495
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: