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General NPI Number Information
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NPI Number | 1114980612
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Entity Type | Organization
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Legal Business Name | PLEASANTON FAMILY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 11030 BOLLINGER CANYON RD # 240
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City | SAN RAMON
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State | CA
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Zip | 94582-4874
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Country | US
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Telephone | 925-736-2200
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Fax | 925-736-6100
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Provider Business Mailing Address
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Address Line | 11030 BOLLINGER CANYON RD # 240
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City | SAN RAMON
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State | CA
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Zip | 94582-4874
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Country | US
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Telephone | 925-736-2200
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Fax | 925-736-6100
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Authorized Official
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Title or Position | CEO
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Name | DR. ALFRED E TAN
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Credential | M.D.
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Telephone | 925-736-2200
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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 | G48933
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License Number State | CA
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