Healthcare Provider Details

I. General information

NPI: 1518939636
Provider Name (Legal Business Name): ROGER AYING TALOB JR. MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROGER AYING TALOB JR. MPAS, PA-C

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 N DINUBA BLVD
VISALIA CA
93291-9003
US

IV. Provider business mailing address

2611 N DINUBA BLVD
VISALIA CA
93291-9003
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0700
  • Fax:
Mailing address:
  • Phone: 559-623-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number16408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: