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General NPI Number Information
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NPI Number | 1679092209
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Entity Type | Organization
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Legal Business Name | TIR VALLEY PLASTIC SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11860 DUBLIN BLVD
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City | DUBLIN
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State | CA
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Zip | 94568-2828
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Country | US
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Telephone | 925-999-4049
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Fax | 925-999-4256
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Provider Business Mailing Address
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Address Line | 11860 DUBLIN BLVD
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City | DUBLIN
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State | CA
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Zip | 94568-2828
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Country | US
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Telephone | 925-999-4049
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Fax | 925-999-4256
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Authorized Official
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Title or Position | SURGERY CENTER MANAGER
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Name | MRS. SARAH MARCHIO
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Credential |
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Telephone | 925-999-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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