Healthcare Provider Details

I. General information

NPI: 1396798195
Provider Name (Legal Business Name): ANDRES TALEISNIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 410
ORANGE CA
92868-3855
US

IV. Provider business mailing address

1310 W STEWART DR STE 410
ORANGE CA
92868-3855
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-8549
  • Fax: 714-538-1547
Mailing address:
  • Phone: 714-538-8549
  • Fax: 714-538-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG68244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: