Healthcare Provider Details

I. General information

NPI: 1700608122
Provider Name (Legal Business Name): EVANGELINA A TALARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD STE 100
MODESTO CA
95355-3362
US

IV. Provider business mailing address

1317 OAKDALE RD STE 440
MODESTO CA
95355-3364
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-3662
  • Fax: 209-522-3362
Mailing address:
  • Phone: 209-522-3662
  • Fax: 209-522-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number315209
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: