Individual
DR. KEIVAN A TAVAKOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PO BOX 364708, SAN JUAN, PR 00936-4708
(787) 758-8383
Mailing address
153 CALLE EBANO, GUAYNABO, PR 00968-3423
(703) 474-0096
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
22049
PR
208D00000X
General Practice Physician
ACN1322
FL
Other
Enumeration date
10/13/2020
Last updated
12/09/2024
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