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General NPI Number Information
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NPI Number | 1801037577
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Entity Type | Organization
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Legal Business Name | LUZ TRISTAN MD INC
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 408 E 3RD ST STE D
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City | CALEXICO
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State | CA
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Zip | 92231-2854
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Country | US
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Telephone | 760-768-5246
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Fax | 760-768-2234
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Provider Business Mailing Address
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Address Line | 408 E 3RD ST STE D
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City | CALEXICO
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State | CA
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Zip | 92231-2854
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Country | US
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Telephone | 760-768-5246
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Fax | 760-768-2234
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. LUZ E TRISTAN
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Credential | MD
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Telephone | 760-768-5246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A064252
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License Number State | CA
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