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General NPI Number Information
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NPI Number | 1992315956
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE TALLAS
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 9745 LAUREL CANYON
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City | PACOIMA
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State | CA
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Zip | 91331
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Country | US
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Telephone | 213-248-0532
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Fax |
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Provider Business Mailing Address
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Address Line | 13909 PINNEY ST
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City | PACOIMA
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State | CA
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Zip | 91331-3624
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Country | US
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Telephone | 213-248-0532
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 89660
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License Number State |
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