Provider Demographics
NPI:1477285948
Name:TRAVIESO, TARIN TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:TARIN
Middle Name:TAYLOR
Last Name:TRAVIESO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E SONTERRA BLVD STE 2201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4287
Mailing Address - Country:US
Mailing Address - Phone:210-496-5792
Mailing Address - Fax:210-496-7601
Practice Address - Street 1:1314 E SONTERRA BLVD STE 2201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4287
Practice Address - Country:US
Practice Address - Phone:210-496-5792
Practice Address - Fax:210-496-7601
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant