MEDICARE: TALIA MEDICAL GROUP, A PROFESSIONAL CORPORATION

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	174400000X	Specialist	015430	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	:	1245330042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALIA MEDICAL GROUP, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	41593 WINCHESTER RD
Second Line	:	STE 101
City	:	TEMECULA
State	:	CA
Zip	:	92590-4860
Country	:	US
Telephone Number	:	951-719-1111
Fax Number	:	951-719-1122

Provider Business Practice Location Address
First Line	:	41593 WINCHESTER RD
Second Line	:	STE 101
City	:	TEMECULA
State	:	CA
Zip	:	92590-4860
Country	:	US
Telephone Number	:	951-719-1111
Fax Number	:	951-719-1122

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MICHAEL S BASCH
Credential	:	M.D.
Telephone Number	:	951-719-1111

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/03/2007

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