Healthcare Provider Details

I. General information

NPI: 1992083877
Provider Name (Legal Business Name): TALYA WALDMAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W THIRD STREET SUITE 740 EAST
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8631 W THIRD STREET SUITE 740 EAST
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9660
  • Fax: 310-423-9668
Mailing address:
  • Phone: 310-423-9660
  • Fax: 310-423-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number15078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: