Provider Demographics
NPI:1356006159
Name:TIRADO, PALOMA
Entity Type:Individual
Prefix:
First Name:PALOMA
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 1:12534 ROSCOE BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3728
Mailing Address - Country:US
Mailing Address - Phone:818-927-9150
Mailing Address - Fax:
Practice Address - Street 1:12534 ROSCOE BLVD APT 3
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3728
Practice Address - Country:US
Practice Address - Phone:818-927-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor