MEDICARE: TRI-VALLEY ECG MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A26164	CA
2	207RC0000X	Cardiovascular Disease Physician	A26164	CA

General Provider Information

NPI Number	:	1962559310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-VALLEY ECG MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	5565 WEST LAS POSITAS BLVD
Second Line	:	SUITE 260
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-460-0700
Fax Number	:	925-734-0517

Provider Business Practice Location Address
First Line	:	5565 WEST LAS POSITAS BLVD
Second Line	:	SUITE 260
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-460-0700
Fax Number	:	925-734-0517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY NOLASCO MUSNI
Credential	:	MD
Telephone Number	:	925-460-0700

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/07/2008

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