Individual
LUZ STELLA TAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED MASSAGE THE
Contact information
Practice address
180 GREAT EAST NECK RD, WEST BABYLON, NY 11704-7821
(407) 620-0760
Mailing address
149 FIRE ISLAND AVE, BABYLON, NY 11702-3907
(407) 620-0760
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
028252-1
NY
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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