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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
3650 SOUTH ST, STE 303, LAKEWOOD, CA 90712-1502
(562) 633-9734
(562) 633-9753
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
Primary
—
CA
207R00000X
Internal Medicine Physician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4143
BUSINESS LICENSE
CA
Enumeration date
10/02/2006
Last updated
08/20/2019
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