Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1356839633 |
---|---|
Provider Name | Sophie Talke |
First Address | San Diego, CA 92107-3530 |
Second Address | San Diego, CA 92103-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 18/10/2018 |