Healthcare Provider Details

I. General information

NPI: 1265975288
Provider Name (Legal Business Name): RAMAN K TALWAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38656 MEDICAL CENTER DR STE A
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

PO BOX 900568
PALMDALE CA
93590-0568
US

V. Phone/Fax

Practice location:
  • Phone: 661-789-7693
  • Fax:
Mailing address:
  • Phone: 661-789-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA40062
License Number StateCA

VIII. Authorized Official

Name: PATTYE OLMACK
Title or Position: BILLER
Credential:
Phone: 818-879-1935