Provider Demographics
NPI:1548341050
Name:TALARICO, MATTHEW THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:TALARICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 POSADA LN STE B
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4056
Mailing Address - Country:US
Mailing Address - Phone:805-434-0900
Mailing Address - Fax:805-434-9260
Practice Address - Street 1:265 POSADA LANE
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4056
Practice Address - Country:US
Practice Address - Phone:805-434-0900
Practice Address - Fax:805-434-9260
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54186207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB234426OtherMEDICARE ID
CAED170XMedicare PIN
CAED170ZMedicare PIN
CAED170WMedicare PIN
CAED170YMedicare PIN
ID721574416OtherTAX ID
IL036103246Medicaid
CAED170XMedicare PIN
CAED170XMedicare PIN