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1144221631

NPI Code Detail

MEDICARE: TALBERT MEDICAL GROUP, P.C.

MEDICARE: TALBERT MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		CA
2	213E00000X	Podiatrist		CA
3	207N00000X	Dermatology Physician		CA
4	207P00000X	Emergency Medicine Physician		CA
5	207Q00000X	Family Medicine Physician		CA
6	207V00000X	Obstetrics & Gynecology Physician		CA
7	207Y00000X	Otolaryngology Physician		CA
8	208000000X	Pediatrics Physician		CA
9	133V00000X	Registered Dietitian		CA
10	174400000X	Specialist		CA
11	207K00000X	Allergy & Immunology Physician		CA
12	207R00000X	Internal Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144221631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBERT MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 6400
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-6400
Country	:	US
Telephone Number	:	310-783-5552
Fax Number	:	310-783-5581

Provider Business Practice Location Address
First Line	:	2925 PALO VERDE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1552
Country	:	US
Telephone Number	:	562-429-2473
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOHN G. LIETHEN
Credential	:
Telephone Number	:	952-205-6262

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/19/2019

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Directions to “TALBERT MEDICAL GROUP, P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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