Healthcare Provider Details

I. General information

NPI: 1144909789
Provider Name (Legal Business Name): MATEUS DE OLIVEIRA TAVEIRA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE FL 3
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1233 YORK AVE APT 14I
NEW YORK NY
10065-6342
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1537
  • Fax: 415-476-0616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA209732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP121147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: