Provider Demographics
NPI:1831412477
Name:TRISTAR
Entity type:Organization
Organization Name:TRISTAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORSUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-378-8552
Mailing Address - Street 1:28844 SOMME CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8974
Mailing Address - Country:US
Mailing Address - Phone:951-378-8552
Mailing Address - Fax:
Practice Address - Street 1:28844 SOMME CT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8974
Practice Address - Country:US
Practice Address - Phone:951-378-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health