Healthcare Provider Details

I. General information

NPI: 1902930753
Provider Name (Legal Business Name): ALLYSON TRACY TEVRIZIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA STE 209 BLDG 2
WALNUT CREEK CA
94598-3034
US

IV. Provider business mailing address

370 N WIGET LN STE 210
WALNUT CREEK CA
94598-2452
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-6252
  • Fax: 925-935-7611
Mailing address:
  • Phone: 925-935-0856
  • Fax: 925-935-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA064305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: