Provider Demographics
NPI:1255100335
Name:TALAMANTEZ, ANGELA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:TALAMANTEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 ALMANOR ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8573
Mailing Address - Country:US
Mailing Address - Phone:707-790-3137
Mailing Address - Fax:
Practice Address - Street 1:326 MISSION AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3425
Practice Address - Country:US
Practice Address - Phone:415-453-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16434314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility