Provider Demographics
NPI:1992083877
Name:WALDMAN, TALYA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TALYA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 W THIRD STREET
Mailing Address - Street 2:SUITE 740 EAST
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-9660
Mailing Address - Fax:310-423-9668
Practice Address - Street 1:8631 W THIRD STREET
Practice Address - Street 2:SUITE 740 EAST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-9660
Practice Address - Fax:310-423-9668
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15078363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health