Healthcare Provider Details

I. General information

NPI: 1023356730
Provider Name (Legal Business Name): TRESTLES PAIN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33171 PASEO CERVEZA 207
SAN JUAN CAPISTRANO CA
92675-4870
US

IV. Provider business mailing address

33171 PASEO CERVEZA 207
SAN JUAN CAPISTRANO CA
92675-4870
US

V. Phone/Fax

Practice location:
  • Phone: 310-650-9401
  • Fax: 949-388-1759
Mailing address:
  • Phone: 310-650-9401
  • Fax: 949-388-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: JOHN GARBINO
Title or Position: OWNER
Credential:
Phone: 310-650-9401