MEDICARE: MARIANA TERESA TAVAREZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	29458-R	PR

General Provider Information

NPI Number	:	1265865679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA TERESA TAVAREZ MD

Provider Business Mailing Address
First Line	:	PASEO DEL REY, APT 3302
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	787-528-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	PASEO DEL REY, APT 3302
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	787-528-1124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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