Basic Information
| Provider Information | |||||||||
| NPI: | 1629283833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAVERNA | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | AMALIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104501143 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7979 WURZBACH RD FL 4 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104501143 | ||||||||
| FaxNumber: | 2104500407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.017321 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | R5478 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | R5478 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 378896001 | 05 | TX | MEDICAID | 378896002 | 01 | TX | CSHCN | OTHER |