Individual
LUIS T TAVAREZ GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 AVE ORTEGON STE 100, GUAYNABO, PR 00966-2516
(787) 425-0525
(787) 425-0526
Mailing address
PO BOX 366255, SAN JUAN, PR 00936-6255
(787) 425-0525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
18155
PR
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
18155
PR
208D00000X
General Practice Physician
18155
PR
390200000X
Student in an Organized Health Care Education/Training Program
18155
PR
Other
Enumeration date
04/07/2011
Last updated
08/31/2021
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