Provider Demographics
NPI:1063688802
Name:TALAMANTES, EFRAIN (MD)
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:TALAMANTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8358
Mailing Address - Country:US
Mailing Address - Phone:310-267-9643
Mailing Address - Fax:310-319-4908
Practice Address - Street 1:1225 15TH ST
Practice Address - Street 2:910
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1101
Practice Address - Country:US
Practice Address - Phone:310-319-4698
Practice Address - Fax:310-319-4908
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109825207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063688802Medicaid
CAEY791ZMedicare PIN