| Tri-valley Family Medicine | |
|
1133 E Stanley Blvd Suite 201 Livermore CA 94550-4200 | |
| (925) 443-9000 | |
| (925) 443-9009 |
| Full Name | Tri-valley Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1133 E Stanley Blvd, Livermore, California |
| Authorized Official Name and Position | Lorena H Tan (OWNER) |
| Authorized Official Contact | 9254439000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-valley Family Medicine 1133 E Stanley Blvd Suite 201 Livermore CA 94550-4200 Ph: (925) 443-9000 | Tri-valley Family Medicine 1133 E Stanley Blvd Suite 201 Livermore CA 94550-4200 Ph: (925) 443-9000 |
| NPI Number | 1245483759 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 11/15/2016 |
| Medicare PECOS PAC ID | 8022164235 |
|---|---|
| Medicare Enrollment ID | O20090914000084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245483759 | NPI | - | NPPES |
| 00A613520 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A61352 (California) | Primary |
| Provider Name | Lorena H Tan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417957697 PECOS PAC ID: 0648238436 Enrollment ID: I20041227000553 |
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