Basic Information
| Provider Information | |||||||||
| NPI: | 1104359439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POMERANTZ | ||||||||
| FirstName: | TALI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4860 Y ST STE 2500 | ||||||||
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| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346978 | ||||||||
| FaxNumber: | 9167346666 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S PRESTON ST | ||||||||
| Address2: | ROOM 305 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028528696 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.