Healthcare Provider Details

I. General information

NPI: 1992397996
Provider Name (Legal Business Name): EMIL PAUL TALABIS URBANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 BROADWAY
OAKLAND CA
94612-3190
US

IV. Provider business mailing address

925 MADISON ST APT 1
ALBANY CA
94706-2041
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-1013
  • Fax:
Mailing address:
  • Phone: 209-914-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: