Provider Demographics
NPI:1922473552
Name:TAVERA, LUZ STELLA (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:STELLA
Last Name:TAVERA
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FIRE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3907
Mailing Address - Country:US
Mailing Address - Phone:407-620-0760
Mailing Address - Fax:
Practice Address - Street 1:180 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7821
Practice Address - Country:US
Practice Address - Phone:407-620-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028252-12083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine