1467758235 NPI number — PRESTIGE MEDICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467758235 NPI number — PRESTIGE MEDICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESTIGE MEDICAL ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467758235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 NEWBURY RD
Provider Second Line Business Mailing Address:
STE. 130
Provider Business Mailing Address City Name:
NEWBURY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91320-6435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-214-3122
Provider Business Mailing Address Fax Number:
805-214-3129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 NEWBURY RD
Provider Second Line Business Practice Location Address:
STE. 130
Provider Business Practice Location Address City Name:
NEWBURY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91320-6435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-214-3122
Provider Business Practice Location Address Fax Number:
805-214-3129
Provider Enumeration Date:
01/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHESNUT
Authorized Official First Name:
TREISE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-217-3334

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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