Provider Demographics
NPI:1417384330
Name:TIRADO, ALEXANDER (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:TIRADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 NE 163RD ST STE 505
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4423
Mailing Address - Country:US
Mailing Address - Phone:786-801-3122
Mailing Address - Fax:305-513-5214
Practice Address - Street 1:3363 NE 163RD ST STE 505
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4423
Practice Address - Country:US
Practice Address - Phone:786-801-3122
Practice Address - Fax:305-513-5214
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2021-07-20
Deactivation Date:2021-06-29
Deactivation Code:
Reactivation Date:2021-07-20
Provider Licenses
StateLicense IDTaxonomies
FLPA9107461207R00000X
FLPAT9107461363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine