Healthcare Provider Details

I. General information

NPI: 1629092473
Provider Name (Legal Business Name): TAL DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TAL SAMUEL DAVID M.D.

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 DIRECTORS PL STE 350
SAN DIEGO CA
92121-3834
US

IV. Provider business mailing address

4445 EASTGATE MALL STE 105
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-9500
  • Fax: 858-453-7314
Mailing address:
  • Phone: 858-412-6080
  • Fax: 858-412-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA69504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: