1184607376 NPI number — ENRIQUE TALAMANTES PA

Table of content: ENRIQUE TALAMANTES PA (NPI 1184607376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184607376 NPI number — ENRIQUE TALAMANTES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALAMANTES
Provider First Name:
ENRIQUE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

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:
1184607376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1763 GROGAN AVE
Provider Second Line Business Mailing Address:
PO BOX 3768
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95341-6455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-725-7149
Provider Business Mailing Address Fax Number:
209-726-0134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9696 STEPHENS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELHI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95315-9550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-667-0702
Provider Business Practice Location Address Fax Number:
209-667-6737
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA17804 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1065229 . This is a "NCCPA CERT #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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