Basic Information
| Provider Information | |||||||||
| NPI: | 1386294619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALINGTING | ||||||||
| FirstName: | GENOR | ||||||||
| MiddleName: | MARINO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7711 S 45TH LN | ||||||||
| Address2: | |||||||||
| City: | LAVEEN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853397322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272712172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2615 E CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937032223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592256100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN145246 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.