Healthcare Provider Details

I. General information

NPI: 1447731542
Provider Name (Legal Business Name): THERESA TALAMANTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 CORONA DR STE 260
CORPUS CHRISTI TX
78411-4395
US

IV. Provider business mailing address

2623 BALCHUCK LN
CORPUS CHRISTI TX
78415-5349
US

V. Phone/Fax

Practice location:
  • Phone: 361-334-1609
  • Fax: 361-906-0478
Mailing address:
  • Phone: 361-739-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number896002
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: