Provider Demographics
NPI:1063881605
Name:TRIVALLEY EAR NOSE THROAT
Entity type:Organization
Organization Name:TRIVALLEY EAR NOSE THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-215-1889
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5989
Mailing Address - Country:US
Mailing Address - Phone:951-698-8222
Mailing Address - Fax:951-698-7411
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:STE 204
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5989
Practice Address - Country:US
Practice Address - Phone:951-698-8222
Practice Address - Fax:951-698-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46300207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty