Provider Demographics
NPI:1598405581
Name:RIVERA TAVAREZ, STEPHANIE (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RIVERA TAVAREZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S MIAMI AVE STE 3008
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4225
Mailing Address - Country:US
Mailing Address - Phone:305-859-7777
Mailing Address - Fax:
Practice Address - Street 1:3659 S MIAMI AVE STE 3008
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4225
Practice Address - Country:US
Practice Address - Phone:305-859-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program