Active NPI
Tali Ehrlich Mayblum
- Pharmacist
- Walnut Creek, CA
National Provider Identifier
1730636002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 62533
- Practice address
- 1123 S California Blvd
Walnut Creek, CA 94596-4413 - Phone
- (925) 933-8353
- Fax
- (925) 933-1935
- NPI assigned
- Sep 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 62533 | CA | Primary |
Addresses
Primary practice location
1123 S California Blvd
Walnut Creek, CA 94596-4413
Mailing address
1123 S California Blvd
Walnut Creek, CA 94596-4413
Phone (925) 933-8353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 941059121 | Other | CA | CVS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62533 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473033600000",
"number": "1730636002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1123 S CALIFORNIA BLVD",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945964413",
"telephone_number": "925-933-8353",
"fax_number": "925-933-1935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1123 S CALIFORNIA BLVD",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945964413",
"telephone_number": "925-933-8353",
"fax_number": "925-933-1935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EHRLICH MAYBLUM",
"first_name": "TALI",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-05",
"last_updated": "2016-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "62533",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CVS",
"identifier": "941059121",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.