Provider Demographics
NPI:1679092209
Name:TIR VALLEY PLASTIC SURGERY CENTER, LLC
Entity type:Organization
Organization Name:TIR VALLEY PLASTIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY CENTER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-999-4049
Mailing Address - Street 1:11860 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2828
Mailing Address - Country:US
Mailing Address - Phone:925-999-4049
Mailing Address - Fax:925-999-4256
Practice Address - Street 1:11860 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2828
Practice Address - Country:US
Practice Address - Phone:925-999-4049
Practice Address - Fax:925-999-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical