Healthcare Provider Details

I. General information

NPI: 1730910175
Provider Name (Legal Business Name): NICOLE TALAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 OTAY LAKES RD STE 110
CHULA VISTA CA
91913-1364
US

IV. Provider business mailing address

2060 OTAY LAKES RD STE 110
CHULA VISTA CA
91913-1364
US

V. Phone/Fax

Practice location:
  • Phone: 619-373-9222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number306483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: