Provider Demographics
NPI:1629087473
Name:TIRADO, GUILLERMO J (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:TIRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7303
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7303
Mailing Address - Country:US
Mailing Address - Phone:787-739-9495
Mailing Address - Fax:787-296-9767
Practice Address - Street 1:140 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3227
Practice Address - Country:US
Practice Address - Phone:787-739-9495
Practice Address - Fax:787-296-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083318Medicare UPIN