MEDICARE: CLARA MARIA TAVAREZ RN

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	163W00000X	Registered Nurse	819809-01	NY

General Provider Information

NPI Number	:	1871220624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA MARIA TAVAREZ RN

Provider Business Mailing Address
First Line	:	120 E 238TH ST APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1803
Country	:	US
Telephone Number	:	646-339-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 44TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-5498
Country	:	US
Telephone Number	:	212-586-6400
Fax Number	:	212-397-7351

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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