Healthcare Provider Details

I. General information

NPI: 1104200971
Provider Name (Legal Business Name): TRI-VALLEY ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 07/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 AVIANO WAY
DUBLIN CA
94568-7338
US

IV. Provider business mailing address

3649 AVIANO WAY
DUBLIN CA
94568-7338
US

V. Phone/Fax

Practice location:
  • Phone: 703-626-2304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA104496
License Number StateCA

VIII. Authorized Official

Name: DALJEET SAMRA
Title or Position: PRESIDENT
Credential:
Phone: 703-626-2304