Individual
HUMBERTO TAVAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 TROUVILLE RD, COPIAGUE, NY 11726-3002
(631) 918-3533
Mailing address
212 TROUVILLE RD, COPIAGUE, NY 11726-3002
(631) 918-3533
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/26/2018
Last updated
01/26/2018
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