1588672612 NPI number — TALOSIG & TALOSIG M D P A

Table of content: (NPI 1588672612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588672612 NPI number — TALOSIG & TALOSIG M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALOSIG & TALOSIG M D P A
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:
1588672612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 SOUTH WINFREE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-258-2624
Provider Business Mailing Address Fax Number:
936-258-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S WINFREE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77535-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-258-2624
Provider Business Practice Location Address Fax Number:
936-258-2488
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TALOSIG
Authorized Official First Name:
SOCORRO
Authorized Official Middle Name:
AGGABAO
Authorized Official Title or Position:
PEDIATRICS
Authorized Official Telephone Number:
936-258-2624

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  F6129 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com