Healthcare Provider Details

I. General information

NPI: 1184808156
Provider Name (Legal Business Name): TRI-VALLEY ORTHOPEDIC AND SPORTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD SUITE 200
PLEASANTON CA
94588-2710
US

IV. Provider business mailing address

4626 WILLOW RD SUITE 200
PLEASANTON CA
94588-2710
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax: 925-463-0473
Mailing address:
  • Phone: 925-469-0939
  • Fax: 925-469-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH RHOTON
Title or Position: BILLING DEPARTMENT MANAGER
Credential:
Phone: 925-469-0939