Healthcare Provider Details

I. General information

NPI: 1992635346
Provider Name (Legal Business Name): MRS. FATIMA GRACE TALAG-TAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE TAM MS CCC

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 ALMA AVE
CASTRO VALLEY CA
94546-3104
US

IV. Provider business mailing address

4400 ALMA AVE
CASTRO VALLEY CA
94546-3104
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-2342
  • Fax:
Mailing address:
  • Phone: 510-537-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: