=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649386673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURIER J. TREMBLAY, JR., M.D., F.A.C.S., A.P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5070 CORTE PLAYA CATALINA
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92124-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-279-3984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5070 CORTE PLAYA CATALINA
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92124-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-279-3984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LAURIER JOSEPH TREMBLAY JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 858-279-3984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G47379
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------