Provider Demographics
NPI:1871220624
Name:TAVAREZ, CLARA MARIA (RN)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:MARIA
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 238TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1803
Mailing Address - Country:US
Mailing Address - Phone:646-339-2503
Mailing Address - Fax:
Practice Address - Street 1:305 W 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-5498
Practice Address - Country:US
Practice Address - Phone:212-586-6400
Practice Address - Fax:212-397-7351
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY819809-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse