Provider Demographics
NPI:1508207234
Name:TVFM, INC.
Entity Type:Organization
Organization Name:TVFM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BOGGELN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-676-8868
Mailing Address - Street 1:28999 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5805
Mailing Address - Country:US
Mailing Address - Phone:951-676-8868
Mailing Address - Fax:951-676-9619
Practice Address - Street 1:28999 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5805
Practice Address - Country:US
Practice Address - Phone:951-676-8868
Practice Address - Fax:951-676-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49322207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51330Medicare UPIN