Provider Demographics
NPI:1396016697
Name:FUENTES TIRADO, ELIMARIS (DPT MSPT)
Entity Type:Individual
Prefix:DR
First Name:ELIMARIS
Middle Name:
Last Name:FUENTES TIRADO
Suffix:
Gender:F
Credentials:DPT MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SAN RAFAEL ESTS
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3072
Mailing Address - Country:US
Mailing Address - Phone:787-552-9757
Mailing Address - Fax:800-543-2713
Practice Address - Street 1:CARR 8860 KM 1.5
Practice Address - Street 2:PLAZA MATIENZO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-400-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist