Basic Information
| Provider Information | |||||||||
| NPI: | 1790835130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIVALLEY OUTPATIENT SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4487 STONERIDGE DR | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945888326 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 9256001908 | ||||||||
| Practice Location | |||||||||
| Address1: | 4487 STONERIDGE DR | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945888326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256001900 | ||||||||
| FaxNumber: | 9256001908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9256001900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.