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 State
1	133V00000X	Registered Dietitian	CA
2	174400000X	Specialist	CA
3	207K00000X	Allergy & Immunology Physician	CA
4	207N00000X	Dermatology Physician	CA
5	207Q00000X	Family Medicine Physician	CA
6	207T00000X	Neurological Surgery Physician	CA
7	207V00000X	Obstetrics & Gynecology Physician	CA
8	208000000X	Pediatrics Physician	CA
9	2085R0202X	Diagnostic Radiology Physician	CA
10	213E00000X	Podiatrist	CA
11	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	:	1679574222
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	:	19066 MAGNOLIA ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2232
Country	:	US
Telephone Number	:	714-968-0068
Fax Number	:	714-378-2188

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/19/2019

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