Provider Demographics
NPI:1609678366
Name:TATUM, TALAR
Entity type:Individual
Prefix:
First Name:TALAR
Middle Name:
Last Name:TATUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12905 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5679
Mailing Address - Country:US
Mailing Address - Phone:239-399-0142
Mailing Address - Fax:
Practice Address - Street 1:12905 GORHAM ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5679
Practice Address - Country:US
Practice Address - Phone:239-399-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator