Healthcare Provider Details

I. General information

NPI: 1003208034
Provider Name (Legal Business Name): TALITHA MOON DO, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 12/04/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUDLAGER 301
APO AE
92249
US

IV. Provider business mailing address

CMR 411 BOX 2481
APO AE
09112-0025
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number1627
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1627
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: