Healthcare Provider Details

I. General information

NPI: 1861697328
Provider Name (Legal Business Name): J. TALISMAN POMEROY, IV, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 N MAIN ST
SOQUEL CA
95073-2204
US

IV. Provider business mailing address

3035 N MAIN ST
SOQUEL CA
95073-2204
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-8750
  • Fax: 831-475-5713
Mailing address:
  • Phone: 831-462-8750
  • Fax: 831-475-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG414340
License Number StateCA

VIII. Authorized Official

Name: MARLYN TASHIRO
Title or Position: MEDICAL BILLER
Credential:
Phone: 831-462-8755