Provider Demographics
NPI:1205266947
Name:TALIB, SAIFUDDIN (FNP)
Entity type:Individual
Prefix:MR
First Name:SAIFUDDIN
Middle Name:
Last Name:TALIB
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50249 CESAR CHAVEZ ST STE K
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1530
Mailing Address - Country:US
Mailing Address - Phone:760-393-0555
Mailing Address - Fax:760-393-0522
Practice Address - Street 1:50249 CESAR CHAVEZ ST STE K
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1530
Practice Address - Country:US
Practice Address - Phone:760-393-0555
Practice Address - Fax:760-393-0522
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010824363LF0000X
CA95010315363LF0000X
IL041.292254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse