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General NPI Number Information
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NPI Number | 1932514940
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Entity Type | Individual
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Provider Name | LUIS J TAVERAS PS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 715 N FERNCREEK AVE SUITE C
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City | ORLANDO
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State | FL
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Zip | 32803-4108
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Country | US
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Telephone | 407-440-4504
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Fax | 407-674-7935
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Provider Business Mailing Address
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Address Line | 715 N FERNCREEK AVE SUITE C
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City | ORLANDO
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State | FL
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Zip | 32803-4108
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Country | US
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Telephone | 407-440-4504
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Fax | 407-674-7935
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS13139
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License Number State | FL
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