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NPI Code Detail

MEDICARE: JESSICA TAVERA

MEDICARE: JESSICA TAVERA
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
1172V00000XCommunity Health Worker
2373H00000XDay Training/Habilitation Specialist
3225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1427364199
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA TAVERA
Provider Business Mailing Address
First Line : 2594 INDUSTRY WAY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4015
Country : US
Telephone Number : 310-667-4071
Fax Number :
Provider Business Practice Location Address
First Line : 2594 INDUSTRY WAY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4015
Country : US
Telephone Number : 310-667-4071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2010
Last Update Date : 05/21/2025

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Directions to “ JESSICA TAVERA ” Practice Location

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