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General NPI Number Information
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NPI Number | 1205921640
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Entity Type | Individual
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Provider Name | MEHRZAD TALLE LAC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1804 N. PLACENTIA AVE
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City | PLACENTIA
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State | CA
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Zip | 92870-2303
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Country | US
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Telephone | 714-528-9400
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Fax | 714-528-9403
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Provider Business Mailing Address
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Address Line | 12 TEPOLITO
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-1503
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Country | US
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Telephone | 949-709-2912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC4386
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License Number State | CA
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