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General NPI Number Information
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NPI Number | 1982842233
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Entity Type | Organization
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Legal Business Name | JANINE M TALTY DO INC
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Dates
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Enumeration Date | 01/25/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 50 PENNY LN
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City | WATSONVILLE
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State | CA
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Zip | 95076-3079
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Country | US
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Telephone | 831-722-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 50 PENNY LN
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City | WATSONVILLE
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State | CA
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Zip | 95076-3079
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Country | US
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Telephone | 831-724-3473
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JANINE MARIE TALTY
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Credential | D.O.
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Telephone | 831-724-3473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 20A6830
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License Number State | CA
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