Individual
MRS. TENISHA D TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1338 PHAY AVE, CANON CITY, CO 81212-2302
(719) 285-2025
Mailing address
1338 PHAY AVE, CANON CITY, CO 81212-2302
(719) 285-2025
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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