Healthcare Provider Details

I. General information

NPI: 1134525140
Provider Name (Legal Business Name): LIVERMORE FAMILY MEDICINE & GERIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 12/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MURRIETA BLVD
LIVERMORE CA
94550-4111
US

IV. Provider business mailing address

PO BOX 1931
PLEASANTON CA
94566-0193
US

V. Phone/Fax

Practice location:
  • Phone: 925-344-4450
  • Fax: 925-344-4451
Mailing address:
  • Phone: 925-344-4450
  • Fax: 925-344-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101095
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA101095
License Number StateCA

VIII. Authorized Official

Name: DR. SANIE ZEHRA
Title or Position: PRESIDENT
Credential: MD
Phone: 925-344-4450