Doctor Name: | CHRISTIAN TALLA |
NPI Number: | 1285045740 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | IN00003758 |
Business Practice Address: | 790 Fairview Ave Apt 618 Takoma Park, MD - 209125979 |
Business Phone Number: | 2402716588 |
Business Fax Number: | |
Mailing Address: | 790 Fairview Ave, Apt 618 TAKOMA PARK |
State: | MD |
Postal Code: | 209125979 |
Phone Number: | 2402716588 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2014 |
NPI Last Update Date: | 05/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | IN00003758 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |