Provider Demographics
NPI:1780422188
Name:TALBERT, DOROTHY ROSE
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ROSE
Last Name:TALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:ROSE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WRAP CERTIFICATE
Mailing Address - Street 1:2021 ESTHER DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1605
Mailing Address - Country:US
Mailing Address - Phone:559-859-3915
Mailing Address - Fax:
Practice Address - Street 1:2021 ESTHER DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1605
Practice Address - Country:US
Practice Address - Phone:559-859-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker