Healthcare Provider Details

I. General information

NPI: 1790166858
Provider Name (Legal Business Name): TALIA M ADAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 THUNDER DR 1ST FLOOR
VISTA CA
92083-6010
US

IV. Provider business mailing address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-5487
  • Fax: 760-630-2558
Mailing address:
  • Phone: 949-923-3277
  • Fax: 855-812-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: