Healthcare Provider Details

I. General information

NPI: 1154309599
Provider Name (Legal Business Name): TAL RENCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

373 COMMONWEALTH AVE #301
BOSTON MA
02115-1815
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6500
  • Fax:
Mailing address:
  • Phone: 617-267-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number222838
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberC144554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: