MEDICARE: DR. LISA TALERICO PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 19743	CA

General Provider Information

NPI Number	:	1164697769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA TALERICO PSY.D.

Provider Business Mailing Address
First Line	:	810 EMERALD ST
Second Line	:	#123
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2712
Country	:	US
Telephone Number	:	619-994-3341
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 EMERALD ST
Second Line	:	#123
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2712
Country	:	US
Telephone Number	:	619-994-3341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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