Provider Demographics
NPI:1437876307
Name:TALLMAN, TERRI LEA
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEA
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-1506
Mailing Address - Country:US
Mailing Address - Phone:760-390-6406
Mailing Address - Fax:
Practice Address - Street 1:3160 FRUITLAND DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-1506
Practice Address - Country:US
Practice Address - Phone:760-390-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN3814940OtherDRIVER LICENSE