Healthcare Provider Details

I. General information

NPI: 1881778546
Provider Name (Legal Business Name): TRI-VALLEY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 W LAS POSITAS BLVD SUITE 240
PLEASANTON CA
94588-4001
US

IV. Provider business mailing address

PO BOX 1319
SALIDA CA
95368-1319
US

V. Phone/Fax

Practice location:
  • Phone: 925-460-8444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA62014
License Number StateCA

VIII. Authorized Official

Name: LIONEL HERRERA
Title or Position: CEO
Credential: M.D.
Phone: 925-460-8444