Healthcare Provider Details

I. General information

NPI: 1336351220
Provider Name (Legal Business Name): JAMIE LEE TALWAR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EAST 31ST STREET
OAKLAND CA
94602
US

IV. Provider business mailing address

22 STOW CT.
SAN RAMON CA
94583
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3667
  • Fax:
Mailing address:
  • Phone: 925-828-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: