Provider Demographics
NPI:1104900711
Name:TRISTANT, STEVE PAUL (DPM)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:PAUL
Last Name:TRISTANT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2215
Mailing Address - Country:US
Mailing Address - Phone:916-722-6163
Mailing Address - Fax:916-729-9306
Practice Address - Street 1:7620 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2215
Practice Address - Country:US
Practice Address - Phone:916-722-6163
Practice Address - Fax:916-729-9306
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3734213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37340Medicaid
U10119Medicare UPIN
CA000E37340Medicaid
CA000E37342Medicare PIN