Basic Information
| Provider Information | |||||||||
| NPI: | 1356694020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN TALIEH MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 577134 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953577134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095220600 | ||||||||
| FaxNumber: | 2094910116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 SPANOS CT STE 203 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095220600 | ||||||||
| FaxNumber: | 2094910116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | TALIEH | ||||||||
| AuthorizedOfficialFirstName: | YAHYA | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 2095220600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | A73331 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.