Individual
LUIS ARMANDO TAVERAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
324 TALISI LOOP, SAINT CLOUD, FL 34771-9162
(407) 961-9002
Mailing address
324 TALISI LOOP, SAINT CLOUD, FL 34771-9162
(407) 961-9002
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1500PA
PR
390200000X
Student in an Organized Health Care Education/Training Program
—
PR
Other
Enumeration date
06/28/2023
Last updated
11/21/2023
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