Healthcare Provider Details

I. General information

NPI: 1821125386
Provider Name (Legal Business Name): MARTIN TRIEB, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 SAMARITAN DR
SAN JOSE CA
95124-3907
US

IV. Provider business mailing address

1121 HIGHLAND RANCH RD
CLOVERDALE CA
95425-4340
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-6771
  • Fax:
Mailing address:
  • Phone: 707-894-8941
  • Fax: 707-894-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG54140
License Number StateCA

VIII. Authorized Official

Name: DR. MARTIN TRIEB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-894-8941