Basic Information
Provider Information
NPI: 1023390606
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TALMICH
FirstName: EMILY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 31309
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900310309
CountryCode: US
TelephoneNumber: 3234429062
FaxNumber:  
Practice Location
Address1: 1450 SAN PABLO ST # 6200
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900335331
CountryCode: US
TelephoneNumber: 3234429062
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/09/2011
LastUpdateDate: 09/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XPA54995CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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