Provider Demographics
NPI:1437700887
Name:TALAMANTES, MIA YOSHIMI (PA-C)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:YOSHIMI
Last Name:TALAMANTES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SPRING ST APT 19
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3647
Mailing Address - Country:US
Mailing Address - Phone:310-906-6100
Mailing Address - Fax:
Practice Address - Street 1:177 FORT WASHINGTON AVE RM 124-A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-342-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant