Provider Demographics
NPI:1467454819
Name:TALIEH, ARDESHIR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:ALI
Last Name:TALIEH
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 1:628 CALIFORNIA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2553
Mailing Address - Country:US
Mailing Address - Phone:805-540-5035
Mailing Address - Fax:805-540-5036
Practice Address - Street 1:628 CALIFORNIA BLVD STE F
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2553
Practice Address - Country:US
Practice Address - Phone:805-540-5035
Practice Address - Fax:805-540-5036
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12028Medicare UPIN
W17166Medicare Oscar/Certification
WA48638FMedicare PIN