Provider Demographics
NPI:1245483759
Name:TRI-VALLEY FAMILY MEDICINE
Entity type:Organization
Organization Name:TRI-VALLEY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-443-9000
Mailing Address - Street 1:1133 E STANLEY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-443-9000
Mailing Address - Fax:925-443-9009
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-443-9000
Practice Address - Fax:925-443-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613520Medicaid
CAG83156Medicare UPIN
CA00A613522Medicare PIN