Provider Demographics
NPI:1801057187
Name:TAVIRA, DOUGLAS HORACIO
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HORACIO
Last Name:TAVIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4556 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2327
Mailing Address - Country:US
Mailing Address - Phone:951-367-7185
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3247
Practice Address - Country:US
Practice Address - Phone:951-955-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health