Glenn Patrick Tajalle

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Practice address

161 Exeter Way
Corona, CA 92882-8502

Phone

(714) 675-9089

NPI assigned

Feb 2, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1003512971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 EXETER WAY",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928828502",
            "telephone_number": "714-675-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 EXETER WAY",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928828502",
            "telephone_number": "714-675-9089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAJALLE",
        "first_name": "GLENN",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-02",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ghasan M. Tabel, MD
• Tabula Rasa Healthcare Group, Inc
• Tabula Rasa Healthcare Group, Inc
• Tactile Systems Technology, Inc
• Tae Eung Jack Kim MD a Medical Corporation
• Joana Anjeh Tala, MD
• Darshita Jaydeep Talim, D.D.S.
• Jaydeep Shashikumar Talim, D.D.S.
• Jaanam Talwar
• Andrew Tam

• Other Specialist/Technologist in Corona, CA
• Providers in Corona, CA by specialty
• Other Specialist/Technologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.