Provider Demographics
NPI:1497363212
Name:TALA, JOANA ANJEH (MD)
Entity type:Individual
Prefix:DR
First Name:JOANA
Middle Name:ANJEH
Last Name:TALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17958
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7958
Mailing Address - Country:US
Mailing Address - Phone:203-394-2681
Mailing Address - Fax:
Practice Address - Street 1:2951 HAMPSHIRE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6133
Practice Address - Country:US
Practice Address - Phone:203-394-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000226305S00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No305S00000XManaged Care OrganizationsPoint of Service