Provider Demographics
NPI:1376932574
Name:TAVARES-ALVARADO, JACQUELINE (LSA, CSFA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TAVARES-ALVARADO
Suffix:
Gender:F
Credentials:LSA, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751763
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77275-1763
Mailing Address - Country:US
Mailing Address - Phone:281-827-6521
Mailing Address - Fax:
Practice Address - Street 1:1826 PLEASANT SPRINGS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-1498
Practice Address - Country:US
Practice Address - Phone:281-827-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156467 NBSTSA246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant