Healthcare Provider Details

I. General information

NPI: 1609987254
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: 08/31/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 W GRANT LINE RD SUITE 100
TRACY CA
95377-7309
US

IV. Provider business mailing address

4626 WILLOW RD SUITE 200
PLEASANTON CA
94588-2710
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-6821
  • Fax: 209-833-3328
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 Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

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