TRI-VALLEY MEDICAL GROUP, INC - NPI NUMBER 1609186832

Summary

Provider Name: TRI-VALLEY MEDICAL GROUP, INC

NPI Number: 1609186832

Clasification: Internal Medicine (207RR0500X)

Specialization: Rheumatology

Address:
39765 DATE ST
SUITE 102
MURRIETA, CA
ZIP 92563

Phone Number: (951) 894-5541



Detailed Information

TRI-VALLEY MEDICAL GROUP, INC is a rheumatology internist in Murrieta, CA. The provider is an internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. The assigned NPI number for this provider is 1609186832 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

39765 DATE ST
SUITE 102
MURRIETA, CA
ZIP 92563-005
Phone: (951) 894-5541
Fax: (951) 894-4773

The provider's authorized official is Charles Payton .
The authorized official title is Vp/chief Medical Officer and has the following contact phone number (909) 335-4101.

The enumeration date for this NPI number is 10/21/2010 and was last updated on 10/21/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207RR0500X Internal Medicine Rheumatology No
2 207V00000X Obstetrics & Gynecology No
3 207R00000X Internal Medicine Yes

NPI Record

No. Field Name Field Value
1 NPI 1609186832
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name TRI-VALLEY MEDICAL GROUP, INC
5 Provider First Line Business Practice Location Address 39765 DATE ST
6 Provider Second Line Business Practice Location Address SUITE 102
7 Provider Business Practice Location Address City Name MURRIETA
8 Provider Business Practice Location Address State Name CA
9 Provider Business Practice Location Address Postal Code 925632005
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 9518945541
12 Provider Business Practice Location Address Fax Number 9518944773
13 Provider Enumeration Date 10/21/2010
14 Last Update Date 10/21/2010
15 Authorized Official Last Name PAYTON
16 Authorized Official First Name CHARLES
17 Authorized Official Title or Position VP/CHIEF MEDICAL OFFICER
18 Authorized Official Telephone Number 9093354101
19 Healthcare Provider Taxonomy Code 1 207RR0500X
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 207V00000X
22 Healthcare Provider Primary Taxonomy Switch 2 N
23 Healthcare Provider Taxonomy Code 3 207R00000X
24 Healthcare Provider Primary Taxonomy Switch 3 Y
25 Is Organization Subpart N
26 Authorized Official Name Prefix Text DR.
27 Authorized Official Credential Text M.D.
28 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
29 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP
30 Healthcare Provider Taxonomy Group 3 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.