Healthcare Provider Details

I. General information

NPI: 1568196806
Provider Name (Legal Business Name): CHIHARA O TALAVERA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

1743 WALTZER RD
SANTA ROSA CA
95403-7675
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7750
  • Fax:
Mailing address:
  • Phone: 408-318-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number73498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number73498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: