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General NPI Number Information
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NPI Number | 1013055722
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Entity Type | Organization
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Legal Business Name | TRI-VALLEY ENDOCRINOLOGY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 5401 NORRIS CANYON RD SUITE 108
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City | SAN RAMON
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State | CA
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Zip | 94583-5409
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Country | US
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Telephone | 925-866-8700
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Fax | 925-866-8701
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Provider Business Mailing Address
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Address Line | 5401 NORRIS CANYON RD SUITE 108
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City | SAN RAMON
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State | CA
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Zip | 94583-5409
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Country | US
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Telephone | 925-866-8700
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Fax | 925-866-8701
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHMOOD KAZEMI
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Credential | M.D.
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Telephone | 925-866-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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