Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | A154190 | CA |
NPI | 1659791101 |
---|---|
Provider Name | Dr. Brian Nabil Talleur |
First Address | Lodi, CA 95242-3525 |
Second Address | Lodi, CA 95242-3525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 18/11/2021 |