Provider Demographics
NPI:1790115947
Name:TAVERAS, ALTAGRACIA (RN)
Entity Type:Individual
Prefix:MS
First Name:ALTAGRACIA
Middle Name:
Last Name:TAVERAS
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 1:105 HAVEN AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2716
Mailing Address - Country:US
Mailing Address - Phone:917-863-9971
Mailing Address - Fax:
Practice Address - Street 1:3940 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1534
Practice Address - Country:US
Practice Address - Phone:718-299-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7956324163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health