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General NPI Number Information
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NPI Number | 1720171325
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Entity Type | Organization
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Legal Business Name | TALBERT MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 3650 SOUTH ST STE 303
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City | LAKEWOOD
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State | CA
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Zip | 90712-1502
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Country | US
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Telephone | 562-633-9734
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Fax | 562-633-9753
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Provider Business Mailing Address
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Address Line | P.O. BOX 6400
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City | TORRANCE
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State | CA
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Zip | 90504-6400
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Country | US
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Telephone | 310-783-5552
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Fax | 310-783-5581
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN G. LIETHEN
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Credential |
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Telephone | 952-205-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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