Healthcare Provider Details

I. General information

NPI: 1598894792
Provider Name (Legal Business Name): TALHA MEMON M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 DATE ST #101
MURRIETA CA
92563-2007
US

IV. Provider business mailing address

39755 DATE ST #101
MURRIETA CA
92563-2007
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-6629
  • Fax: 951-698-8732
Mailing address:
  • Phone: 951-698-6629
  • Fax: 951-698-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA41831
License Number StateCA

VIII. Authorized Official

Name: TALHA MEMON
Title or Position: OWNER
Credential: MD
Phone: 949-293-2748