Healthcare Provider Details

I. General information

NPI: 1043853633
Provider Name (Legal Business Name): DEBIE LAM TALOVERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 JACKSON ST STE 207
RIVERSIDE CA
92503-3948
US

IV. Provider business mailing address

5038 BIRCH ST UNIT 326
MONTCLAIR CA
91763-3071
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-2092
  • Fax:
Mailing address:
  • Phone: 909-346-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPA58277
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: