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Organization
DAVITA MEDICAL GROUP TALBERT CALIFORNIA, P.C.
Active
Organization
DAVITA MEDICAL GROUP TALBERT CALIFORNIA, P.C.
Active
Other names
Talbert Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
1236 N MAGNOLIA AVE, ANAHEIM, CA 92801-2607
(714) 995-1000
(714) 828-7926
Mailing address
P.O. BOX 6400, TORRANCE, CA 90504-6400
(310) 783-5552
(310) 783-5581
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
CA
207K00000X
Allergy & Immunology Physician
—
CA
207N00000X
Dermatology Physician
—
CA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
CA
207Q00000X
Family Medicine Physician
Primary
—
CA
207R00000X
Internal Medicine Physician
—
CA
207V00000X
Obstetrics & Gynecology Physician
—
CA
207W00000X
Ophthalmology Physician
—
CA
207Y00000X
Otolaryngology Physician
—
CA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
CA
208000000X
Pediatrics Physician
—
CA
2084N0400X
Neurology Physician
—
CA
208600000X
Surgery Physician
—
CA
208800000X
Urology Physician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0077863
—
CA
Enumeration date
08/04/2005
Last updated
08/19/2019
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