Provider Demographics
NPI:1003027095
Name:TIRADO, MAYRA IVETTE (ENFERMERA)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:IVETTE
Last Name:TIRADO
Suffix:
Gender:F
Credentials:ENFERMERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIANA 3 CARRETERA 183
Mailing Address - Street 2:A-17 SANTA ROSA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0725
Mailing Address - Country:US
Mailing Address - Phone:787-647-7158
Mailing Address - Fax:787-745-2165
Practice Address - Street 1:DIANA 3 CARRETERA 183
Practice Address - Street 2:A-17 SANTA ROSA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0725
Practice Address - Country:US
Practice Address - Phone:787-647-7158
Practice Address - Fax:787-745-2165
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44483747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider