Healthcare Provider Details

I. General information

NPI: 1497759005
Provider Name (Legal Business Name): TALBERT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 SCENIC AVE STE 100
COSTA MESA CA
92626-1443
US

IV. Provider business mailing address

PO BOX 6400
TORRANCE CA
90504-0400
US

V. Phone/Fax

Practice location:
  • Phone: 310-354-4221
  • Fax:
Mailing address:
  • Phone: 310-783-5552
  • Fax: 310-783-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberFNP26902
License Number StateCA

VIII. Authorized Official

Name: ROBERT J. MARGOLIS
Title or Position: C.E.O.
Credential: MD
Phone: 310-354-4221