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Organization
TALBERT MEDICAL GROUP, P.C.
Active
Organization
TALBERT MEDICAL GROUP, 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
500 ALAMITOS AVE, LONG BEACH, CA 90802-1614
(562) 432-5661
Mailing address
P.O. BOX 6400, TORRANCE, CA 90504-6400
(310) 783-5552
(310) 783-5581
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
CA
207R00000X
Internal Medicine Physician
Primary
—
CA
207V00000X
Obstetrics & Gynecology Physician
—
CA
208000000X
Pediatrics Physician
—
CA
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
CA
2085R0202X
Diagnostic Radiology Physician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0077866
—
CA
Enumeration date
08/09/2005
Last updated
08/19/2019
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