Provider Demographics
NPI:1669991642
Name:TALAVERA, XIMENA ALEXANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:XIMENA
Middle Name:ALEXANDRA
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:XIMENA
Other - Middle Name:ALEXANDRA
Other - Last Name:BARBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11226 GREEN ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2532
Mailing Address - Country:US
Mailing Address - Phone:951-235-1986
Mailing Address - Fax:
Practice Address - Street 1:4211 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3502
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA43662355S0801X
CASP32056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant