Provider Demographics
NPI:1124141049
Name:TREAIS, LYN MARIE (MD)
Entity type:Individual
Prefix:
First Name:LYN
Middle Name:MARIE
Last Name:TREAIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:M
Other - Last Name:TREAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-2758
Mailing Address - Country:US
Mailing Address - Phone:415-235-3542
Mailing Address - Fax:
Practice Address - Street 1:400 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4017
Practice Address - Country:US
Practice Address - Phone:831-770-0123
Practice Address - Fax:831-753-9717
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86960207Q00000X
UT378891-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A869600Medicaid