=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326850793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AIMEE PATRICIA TAVAREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 551 W 157TH ST APT 62
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-7653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-283-1227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 551 W 157TH ST APT 62
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-7653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-283-1227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1697297231
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------