Healthcare Provider Details

I. General information

NPI: 1437361680
Provider Name (Legal Business Name): FERDIE TALENTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 SUN CENTER DR SUITE G
RANCHO CORDOVA CA
95670-6161
US

IV. Provider business mailing address

11121 SUN CENTER DR SUITE G
RANCHO CORDOVA CA
95670-6161
US

V. Phone/Fax

Practice location:
  • Phone: 916-631-0112
  • Fax: 916-631-1652
Mailing address:
  • Phone: 916-631-0112
  • Fax: 916-631-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberMTA 40677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1190
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: