Provider Demographics
NPI:1518552165
Name:TAVARES, LIZZBETH (RN)
Entity Type:Individual
Prefix:MISS
First Name:LIZZBETH
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 I ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3639
Mailing Address - Country:US
Mailing Address - Phone:760-604-9139
Mailing Address - Fax:
Practice Address - Street 1:1463 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4749
Practice Address - Country:US
Practice Address - Phone:760-594-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95200863163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse