Provider Demographics
NPI:1518939636
Name:TALOB, ROGER AYING JR (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:AYING
Last Name:TALOB
Suffix:JR
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:MR
Other - First Name:ROGER
Other - Middle Name:AYING
Other - Last Name:TALOB
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:813 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11899 SHAW PLACE
Practice Address - Street 2:ADVENTIST HEALTH COMMUNITY CARE, HOME GARDEN
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-585-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant