Provider Demographics
NPI:1538198114
Name:TREMBLAY, ROBERT J (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17595 VIERRA CANYON RD
Mailing Address - Street 2:#230
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-3312
Mailing Address - Country:US
Mailing Address - Phone:209-827-4407
Mailing Address - Fax:
Practice Address - Street 1:911 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5602
Practice Address - Country:US
Practice Address - Phone:831-636-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP5174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P72585Medicare UPIN