Provider Demographics
NPI:1487926986
Name:TAVERAS, OBDULIA
Entity type:Individual
Prefix:MRS
First Name:OBDULIA
Middle Name:
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 6972
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9574
Mailing Address - Country:US
Mailing Address - Phone:787-602-8882
Mailing Address - Fax:
Practice Address - Street 1:HC 6 BOX 6972
Practice Address - Street 2:SECTOR EL LLANO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9574
Practice Address - Country:US
Practice Address - Phone:787-602-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006933164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse