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NPI Code Detail

MEDICARE: DR. TRISHA SIMONE TAVARES M.D.

MEDICARE: DR. TRISHA SIMONE TAVARES M.D.
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
1208000000XPediatrics Physician48619AZ
22080P0207XPediatric Hematology & Oncology Physician232402NY
3207Q00000XFamily Medicine Physician48619AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447461520
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRISHA SIMONE TAVARES M.D.
Provider Business Mailing Address
First Line : 3101 N CENTRAL AVE STE 550
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2635
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-230-5105
Provider Business Practice Location Address
First Line : 3033 N CENTRAL AVE STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2806
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-257-8029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 11/21/2023

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Directions to “ DR. TRISHA SIMONE TAVARES M.D.” Practice Location

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