MEDICARE: TALIA PRIMARY AND SPECIALTY CARE CLINIC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760376081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALIA PRIMARY AND SPECIALTY CARE CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 16297
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2297
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 PAINTED MIRAGE RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4592
Country	:	US
Telephone Number	:	661-425-0295
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERTO SANTANA
Credential	:
Telephone Number	:	661-425-0295

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	12/02/2025

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