Healthcare Provider Details

I. General information

NPI: 1588493258
Provider Name (Legal Business Name): TALI FAGGIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

10385 CAMINITO ALVAREZ
SAN DIEGO CA
92126-5833
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7406
  • Fax:
Mailing address:
  • Phone: 661-964-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: