Healthcare Provider Details

I. General information

NPI: 1225512825
Provider Name (Legal Business Name): LATONYA TALIFERRO DPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 BUILD AMERICA DR
HAMPTON VA
23666-3223
US

IV. Provider business mailing address

48 HAMPSHIRE GLEN PKWY
HAMPTON VA
23669-4806
US

V. Phone/Fax

Practice location:
  • Phone: 757-218-5640
  • Fax:
Mailing address:
  • Phone: 757-218-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: