Healthcare Provider Details

I. General information

NPI: 1336408053
Provider Name (Legal Business Name): CHRISTINA MARIE TALERICO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

IV. Provider business mailing address

125 SAVANNAH SQ
FAIRHOPE AL
36532-6342
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-0153
  • Fax:
Mailing address:
  • Phone: 251-689-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34045
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: