Provider Demographics
NPI:1851617278
Name:TRI VALLEY PLASTIC SURGERYPROFESSIONAL MEDICAL CORPOR
Entity Type:Organization
Organization Name:TRI VALLEY PLASTIC SURGERYPROFESSIONAL MEDICAL CORPOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCARRUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-875-0700
Mailing Address - Street 1:11820 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2830
Mailing Address - Country:US
Mailing Address - Phone:925-875-0700
Mailing Address - Fax:925-875-0576
Practice Address - Street 1:11820 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2830
Practice Address - Country:US
Practice Address - Phone:925-875-0700
Practice Address - Fax:925-875-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty