Provider Demographics
NPI:1932564879
Name:TRI VALLEY ALLERGY
Entity Type:Organization
Organization Name:TRI VALLEY ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-626-2304
Mailing Address - Street 1:1038 MURRIETA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4151
Mailing Address - Country:US
Mailing Address - Phone:925-391-0999
Mailing Address - Fax:
Practice Address - Street 1:1038 MURRIETA BLVD STE B
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4151
Practice Address - Country:US
Practice Address - Phone:925-391-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty