Provider Demographics
NPI:1740672823
Name:TALI FAYFEL APC
Entity type:Organization
Organization Name:TALI FAYFEL APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TALI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYFEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:310-883-3993
Mailing Address - Street 1:16822 VIA LA COSTA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1970
Mailing Address - Country:US
Mailing Address - Phone:310-883-3993
Mailing Address - Fax:818-762-7117
Practice Address - Street 1:16822 VIA LA COSTA
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-1970
Practice Address - Country:US
Practice Address - Phone:310-883-3993
Practice Address - Fax:818-762-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23020251G00000X, 261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital