Provider Demographics
NPI:1124890710
Name:TAVAREZ, ARIEL
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:TAVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5516
Mailing Address - Country:US
Mailing Address - Phone:575-597-0211
Mailing Address - Fax:
Practice Address - Street 1:1000 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5516
Practice Address - Country:US
Practice Address - Phone:575-597-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator