Individual
LAURA TAVAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
138 S MAIN ST, FORKED RIVER, NJ 08731-3625
(609) 756-0000
Mailing address
138 S MAIN ST, FORKED RIVER, NJ 08731-3625
(609) 756-0000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA09703900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2012
Last updated
07/27/2021
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