Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC 25940 | CA |
NPI | 1669461885 |
---|---|
Provider Name | Dr. Barry Mark Triestman |
First Address | Truckee, CA 96161-1716 |
Second Address | Truckee, CA 96161-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 10/05/2020 |