Provider Demographics
NPI:1316131857
Name:ARISTEO TAVARES
Entity type:Organization
Organization Name:ARISTEO TAVARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARISTEO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-992-4453
Mailing Address - Street 1:3711 N HARBOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1362
Mailing Address - Country:US
Mailing Address - Phone:714-992-4453
Mailing Address - Fax:714-992-5543
Practice Address - Street 1:3711 N HARBOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1362
Practice Address - Country:US
Practice Address - Phone:714-992-4453
Practice Address - Fax:714-992-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5956610001Medicare NSC