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General NPI Number Information
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NPI Number | 1770044505
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Entity Type | Individual
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Provider Name | AUDREY KYRA TEMPELSMAN BIALOS DO
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 500 SAN PABLO AVE
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City | ALBANY
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State | CA
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Zip | 94706-1103
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Country | US
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Telephone | 510-204-8130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 510-204-8130
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 19592
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 20A19592
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License Number State | CA
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