Provider Demographics
NPI:1316319171
Name:TALAGA, JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:TALAGA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4806
Mailing Address - Country:US
Mailing Address - Phone:916-803-3176
Mailing Address - Fax:
Practice Address - Street 1:1950 ADDISON ST STE 109
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1182
Practice Address - Country:US
Practice Address - Phone:510-239-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32460103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist