Provider Demographics
NPI:1235595158
Name:TAVARES, MARIA TIAGO
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TIAGO
Last Name:TAVARES
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 1:28 HOWARD SQ
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5113
Mailing Address - Country:US
Mailing Address - Phone:774-417-4090
Mailing Address - Fax:
Practice Address - Street 1:28 HOWARD SQ
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5113
Practice Address - Country:US
Practice Address - Phone:774-417-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health