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General NPI Number Information
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NPI Number | 1760376081
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Entity Type | Organization
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Legal Business Name | TALIA PRIMARY AND SPECIALTY CARE CLINIC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5550 PAINTED MIRAGE RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89149-4592
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Country | US
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Telephone | 661-425-0295
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16297
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-2297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERTO SANTANA
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Credential |
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Telephone | 661-425-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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