Provider Demographics
NPI:1831384122
Name:TALBOTT, MICHELLE ANNE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:TALBOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3521
Mailing Address - Country:US
Mailing Address - Phone:562-528-2139
Mailing Address - Fax:562-438-6891
Practice Address - Street 1:5543 ATLANTIC AVE STE B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5412
Practice Address - Country:US
Practice Address - Phone:562-612-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190077AHNMedicaid