Provider Demographics
NPI:1275247546
Name:TAVAREZ, ERIKA (CMF)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 WOODALL ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5521
Mailing Address - Country:US
Mailing Address - Phone:915-540-5195
Mailing Address - Fax:915-201-1318
Practice Address - Street 1:3028 WOODALL ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5521
Practice Address - Country:US
Practice Address - Phone:915-540-5195
Practice Address - Fax:915-201-1318
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C53846224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
C53846OtherTHE BOARD OF CERTIFICATION