Healthcare Provider Details

I. General information

NPI: 1245043546
Provider Name (Legal Business Name): TOSCA TALIA MAGNUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 TELEGRAPH AVE
BERKELEY CA
94705-2031
US

IV. Provider business mailing address

3654 OLD BLACKHAWK RD
DANVILLE CA
94506-4672
US

V. Phone/Fax

Practice location:
  • Phone: 415-404-3168
  • Fax:
Mailing address:
  • Phone: 925-727-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95032310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: