Provider Demographics
NPI:1306374319
Name:TIRADO, MARTARIS
Entity Type:Individual
Prefix:
First Name:MARTARIS
Middle Name:
Last Name:TIRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 CARR 2
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4247
Mailing Address - Country:US
Mailing Address - Phone:787-807-1106
Mailing Address - Fax:787-807-1144
Practice Address - Street 1:3950 CARR 2
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4247
Practice Address - Country:US
Practice Address - Phone:787-807-1106
Practice Address - Fax:787-807-1144
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist