Individual provider Active NPI

Ivette Y Talavera, PHARMD.

  • Pharmacist
  • San Antonio, TX
National Provider Identifier
1386994168
Registry record updated Dec 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
45457 Issued in TX
Practice address
191 W Loop 1604 S
San Antonio, TX 78245-4191
Phone
(210) 868-6735
Fax
(210) 868-6726
NPI assigned
Sep 19, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 45457 TX Primary

Addresses

Primary practice location

191 W Loop 1604 S
San Antonio, TX 78245-4191

Mailing address

191 W Loop 1604 S
San Antonio, TX 78245-4191
Phone (210) 868-6735

Other names 1

  • Dr. Ivette Y Trevizo Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
45457TXMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735344000000",
    "number": "1386994168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 W LOOP 1604 S",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782454191",
            "telephone_number": "210-868-6735",
            "fax_number": "210-868-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 W LOOP 1604 S",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782454191",
            "telephone_number": "210-868-6735",
            "fax_number": "210-868-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALAVERA",
        "first_name": "IVETTE",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "PHARMD.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2024-12-28",
        "certification_date": "2024-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "45457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVETTE",
            "last_name": "TREVIZO",
            "middle_name": "Y",
            "prefix": "DR.",
            "credential": "PHARMD.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.