Healthcare Provider Details

I. General information

NPI: 1154235430
Provider Name (Legal Business Name): TALITHA JANEK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 FENTON ST
CHULA VISTA CA
91914-3517
US

IV. Provider business mailing address

1251 SANTA CORA AVE APT 1536
CHULA VISTA CA
91913-1753
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: