Healthcare Provider Details

I. General information

NPI: 1598595837
Provider Name (Legal Business Name): JAMES EDWARD TALBERT-IRVING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD
MAITLAND FL
32751-7226
US

IV. Provider business mailing address

3976 KNOTT DR
APOPKA FL
32712-6438
US

V. Phone/Fax

Practice location:
  • Phone: 407-618-0495
  • Fax:
Mailing address:
  • Phone: 407-448-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: