Healthcare Provider Details

I. General information

NPI: 1497363212
Provider Name (Legal Business Name): JOANA ANJEH TALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 HAMPSHIRE CIR
CORONA CA
92879-6133
US

IV. Provider business mailing address

PO BOX 17958
IRVINE CA
92623-7958
US

V. Phone/Fax

Practice location:
  • Phone: 203-394-2681
  • Fax:
Mailing address:
  • Phone: 203-394-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number000226
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: