Tri-Valleyob-GYN Medical Group Inc

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ZZZ73778Z Issued in CA

Legal business name

TRI-VALLEYOB-GYN MEDICAL GROUP INC

Practice address

1133 E Stanley Blvd
Suite 205
Livermore, CA 94550-4200

Phone

(925) 447-1010

Fax

(925) 447-0736

NPI assigned

Dec 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael David Bleecker, M.D.

Title

President

Phone

(925) 447-1010

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629137534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD",
            "address_2": "SUITE 205",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504200",
            "telephone_number": "925-447-1010",
            "fax_number": "925-447-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD",
            "address_2": "SUITE 205",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504200",
            "telephone_number": "925-447-1010",
            "fax_number": "925-447-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VALLEYOB-GYN MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLEECKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-447-1010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "ZZZ73778Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73778Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Livermore, CA
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.