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General NPI Number Information
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NPI Number | 1548919400
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Entity Type | Individual
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Provider Name | JOAN MANUEL RODRIGUEZ TAVERAS MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-8689
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Fax | 401-444-4652
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Provider Business Mailing Address
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Address Line | 801 MASSACHUSETTS AVE FL 6
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City | BOSTON
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State | MA
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Zip | 02118-2605
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Country | US
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Telephone | 617-414-5951
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Fax | 617-414-9251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | LP06520
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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