Individual
JONATHAN B. TALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12 W BEACH ST, WATSONVILLE, CA 95076-4504
(831) 763-8990
Mailing address
1400 EMELINE AVE, 1080 EMELINE AVE., SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A69336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A693360
—
CA
01
—
A69336
MEDICAL LICENSE #
CA
01
—
ZZZ91891Z
MEDICARE GROUP ID#
CA
01
—
ZZZ91892Z
MEDICARE GROUP ID#
CA
01
—
ZZZ92069Z
MEDICARE GROUP ID#
CA
01
—
ZZZ92073Z
MEDICARE GROUP ID#
CA
Enumeration date
07/12/2006
Last updated
03/07/2023
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