Provider Demographics
NPI:1447311899
Name:TREGER, PAUL LESLIE (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LESLIE
Last Name:TREGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7877 PARKWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2000
Mailing Address - Country:US
Mailing Address - Phone:619-460-9077
Mailing Address - Fax:619-460-2184
Practice Address - Street 1:7877 PARKWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2000
Practice Address - Country:US
Practice Address - Phone:619-460-9077
Practice Address - Fax:619-460-2184
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26803207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3846220001OtherNORIDIAN PROVIDER NUMBER FOR DME
CA00G637271Medicaid
CAWG63727BMedicare ID - Type Unspecified
CA00G637271Medicaid