Basic Information
| Provider Information | |||||||||
| NPI: | 1891315891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALIGATOS | ||||||||
| FirstName: | ANNA LIEZL | ||||||||
| MiddleName: | DE CLARO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1785 E SAHARA AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891043733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022528342 | ||||||||
| FaxNumber: | 7022528349 | ||||||||
| Practice Location | |||||||||
| Address1: | 1785 E SAHARA AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891043733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022528342 | ||||||||
| FaxNumber: | 7022528349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.