Healthcare Provider Details

I. General information

NPI: 1205216694
Provider Name (Legal Business Name): KELLI TAVARES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 JOE BATTLE BLVD
EL PASO TX
79938-2622
US

IV. Provider business mailing address

5130 GATEWAY BLVD E
EL PASO TX
79905-1608
US

V. Phone/Fax

Practice location:
  • Phone: 915-832-2000
  • Fax:
Mailing address:
  • Phone: 915-215-4480
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19161
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberU7529
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberU7529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: