Healthcare Provider Details

I. General information

NPI: 1629111919
Provider Name (Legal Business Name): INGRID E TRENKLE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E OLIVE AVE
REDLANDS CA
92373-5250
US

IV. Provider business mailing address

124 E OLIVE AVE
REDLANDS CA
92373-5250
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-2018
  • Fax: 909-335-1641
Mailing address:
  • Phone: 909-335-2018
  • Fax: 909-335-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG27162
License Number StateCA

VIII. Authorized Official

Name: INGRID E TRENKLE
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 909-335-2018