Provider Demographics
NPI:1831628551
Name:ROBERTO TALAMANTES MD PA
Entity type:Organization
Organization Name:ROBERTO TALAMANTES MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAMANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-1378
Mailing Address - Street 1:2903 HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4701
Mailing Address - Country:US
Mailing Address - Phone:575-521-1378
Mailing Address - Fax:575-522-5744
Practice Address - Street 1:2903 HILLRISE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4701
Practice Address - Country:US
Practice Address - Phone:575-521-1378
Practice Address - Fax:575-522-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-2732080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1851436257Medicaid