Provider Demographics
NPI:1750622247
Name:FAYFEL, TALI FINKELSTEIN
Entity type:Individual
Prefix:MRS
First Name:TALI
Middle Name:FINKELSTEIN
Last Name:FAYFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TALI
Other - Middle Name:
Other - Last Name:FINKELSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1470 PASEO DE ORO
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1961
Mailing Address - Country:US
Mailing Address - Phone:310-883-3993
Mailing Address - Fax:818-762-7171
Practice Address - Street 1:12626 RIVERSIDE DR STE 408
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3453
Practice Address - Country:US
Practice Address - Phone:818-762-7171
Practice Address - Fax:818-762-7117
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily