Provider Demographics
NPI:1114614138
Name:TALAMANTES, MAIRA APOLONIA
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:APOLONIA
Last Name:TALAMANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19114 CARRETA DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3016
Mailing Address - Country:US
Mailing Address - Phone:626-589-9661
Mailing Address - Fax:
Practice Address - Street 1:19114 CARRETA DR
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3016
Practice Address - Country:US
Practice Address - Phone:626-589-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)