Provider Demographics
NPI:1194718254
Name:TROMPETTO, BRENT THOMAS (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:THOMAS
Last Name:TROMPETTO
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 1:2755 ALAMO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1311
Mailing Address - Country:US
Mailing Address - Phone:805-210-7280
Mailing Address - Fax:805-210-7290
Practice Address - Street 1:2755 ALAMO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1311
Practice Address - Country:US
Practice Address - Phone:805-210-7280
Practice Address - Fax:805-210-7290
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71617Medicare UPIN