Provider Demographics
NPI:1720205362
Name:TRI VALLEY NEUROSURGICAL MEDICAL GROUP
Entity Type:Organization
Organization Name:TRI VALLEY NEUROSURGICAL MEDICAL GROUP
Other - Org Name:DESMON ERASMUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ERASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-790-6317
Mailing Address - Street 1:39039 PASEO PADRE PKWY
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1620
Mailing Address - Country:US
Mailing Address - Phone:510-790-6317
Mailing Address - Fax:510-790-6383
Practice Address - Street 1:39039 PASEO PADRE PKWY
Practice Address - Street 2:SUITE # 207
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1620
Practice Address - Country:US
Practice Address - Phone:510-790-6317
Practice Address - Fax:510-790-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27459ZMedicare ID - Type UnspecifiedDESMOND ERASMUS,MD