Provider Demographics
NPI:1417534272
Name:TALAVERA, LIVAN
Entity Type:Individual
Prefix:
First Name:LIVAN
Middle Name:
Last Name:TALAVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 SW 131ST CT APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5285
Mailing Address - Country:US
Mailing Address - Phone:786-470-4617
Mailing Address - Fax:
Practice Address - Street 1:6203 SW 131ST CT APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5285
Practice Address - Country:US
Practice Address - Phone:786-470-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker