Provider Demographics
NPI:1992124978
Name:GEOFFREY TRENKLE DO A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:GEOFFREY TRENKLE DO A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TRENKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-553-3445
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2434
Mailing Address - Country:US
Mailing Address - Phone:909-569-9097
Mailing Address - Fax:323-268-6738
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:909-569-9097
Practice Address - Fax:323-268-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13166207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty