Provider Demographics
NPI:1144717943
Name:TALANGA, MARIO (DO)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:TALANGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:BAYONET POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6716
Mailing Address - Country:US
Mailing Address - Phone:727-861-9800
Mailing Address - Fax:207-436-9933
Practice Address - Street 1:7575 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-6716
Practice Address - Country:US
Practice Address - Phone:727-861-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO5931207R00000X
390200000X
FLOS17023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program