Healthcare Provider Details

I. General information

NPI: 1336309137
Provider Name (Legal Business Name): AMBER MARIE TALBOT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 06/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 TRASK AVE
WESTMINSTER CA
92683-2626
US

IV. Provider business mailing address

7071 CERRITOS AVE
STANTON CA
90680-1975
US

V. Phone/Fax

Practice location:
  • Phone: 714-889-4111
  • Fax:
Mailing address:
  • Phone: 714-943-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number29050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: