Provider Demographics
NPI:1538942974
Name:NAKATA, TALIA
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:NAKATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 MONTEFRIO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2280
Mailing Address - Country:US
Mailing Address - Phone:858-688-4845
Mailing Address - Fax:
Practice Address - Street 1:6519 DEL PLAYA DR
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-5116
Practice Address - Country:US
Practice Address - Phone:858-688-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic