Healthcare Provider Details

I. General information

NPI: 1437619160
Provider Name (Legal Business Name): NOA TAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 ARIZONA AVE
SANTA MONICA CA
90404-1337
US

IV. Provider business mailing address

2125 ARIZONA AVE
SANTA MONICA CA
90404-1337
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-7450
  • Fax:
Mailing address:
  • Phone: 310-582-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA177342
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA177342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: