Healthcare Provider Details

I. General information

NPI: 1881508737
Provider Name (Legal Business Name): MRS. GUISELA TAVARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

IV. Provider business mailing address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-7700
  • Fax: 213-989-7700
Mailing address:
  • Phone: 213-989-7700
  • Fax: 213-989-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number730645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: