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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