Healthcare Provider Details

I. General information

NPI: 1356386403
Provider Name (Legal Business Name): EMELITA TALAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2972
  • Fax: 916-734-3384
Mailing address:
  • Phone: 916-734-2972
  • Fax: 916-734-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA92488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: