Provider Demographics
NPI:1982842233
Name:JANINE M TALTY DO INC
Entity Type:Organization
Organization Name:JANINE M TALTY DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TALTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-724-3473
Mailing Address - Street 1:50 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3079
Mailing Address - Country:US
Mailing Address - Phone:831-724-3473
Mailing Address - Fax:
Practice Address - Street 1:50 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3079
Practice Address - Country:US
Practice Address - Phone:831-722-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-25
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6830204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A68300Medicare UPIN