Provider Demographics
NPI:1922984046
Name:TALAVERA, SASHA KENNERLY
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:KENNERLY
Last Name:TALAVERA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3618
Mailing Address - Country:US
Mailing Address - Phone:831-464-5630
Mailing Address - Fax:
Practice Address - Street 1:250 WASHBURN AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3730
Practice Address - Country:US
Practice Address - Phone:831-464-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach