1356625214 NPI number — THE TALK TEAM

Table of content: (NPI 1356625214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356625214 NPI number — THE TALK TEAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE TALK TEAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356625214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1752 E BULLARD AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710-5864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-970-8277
Provider Business Mailing Address Fax Number:
559-549-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1752 E BULLARD AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-970-8277
Provider Business Practice Location Address Fax Number:
559-549-6261
Provider Enumeration Date:
10/10/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
AMY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
559-970-8277

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-09-6445 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-11-8245 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 13262 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 14578 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 18888 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)