Provider Demographics
NPI:1558055434
Name:TALBO, JANELLE DEFIESTA
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:DEFIESTA
Last Name:TALBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:DEGUZMAN
Other - Last Name:DEFIESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CCM
Mailing Address - Street 1:1404 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1316
Mailing Address - Country:US
Mailing Address - Phone:707-708-1334
Mailing Address - Fax:
Practice Address - Street 1:1404 CYPRESS LN
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1316
Practice Address - Country:US
Practice Address - Phone:707-708-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95222451163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management