MEDICARE: JACQUELINE TAVARES-ALVARADO LSA, CSFA

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	246ZC0007X	Surgical Assistant	156467 NBSTSA	TX
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1376932574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE TAVARES-ALVARADO LSA, CSFA

Provider Business Mailing Address
First Line	:	PO BOX 751763
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77275-1763
Country	:	US
Telephone Number	:	281-827-6521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 PLEASANT SPRINGS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-1498
Country	:	US
Telephone Number	:	281-827-6521
Fax Number	:

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

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	05/22/2020

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