Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marielle Tavares

Individual provider Family Nurse Practitioner · NPI 1376282475

Marielle Tavares is a Nurse Practitioner in Los Angeles, California. Graduated from University of Southern California Keck School of Medicine in 2021, 5 years ago. Practices with Ehab Yacoub MD Inc, a 175-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
5
Trained at
University of Southern California Keck School of Medicine
Licensed in
CA
In the registry since
2022
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Practice location Address checks out

808 W 58th St
Los Angeles, CA 90037-3632
Phone: (310) 948-6356
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95020541 (CA)

Record details

NPI number1376282475
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 27, 2022
Last updated in NPPESMay 27, 2022
Certification dateMay 27, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated 2021 (5 years in practice)
Group practice Ehab Yacoub Md Inc — 175 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Los Angeles