Provider Demographics
NPI:1659665784
Name:TIRADO, CARMEN L
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
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:NABORIA E-40
Mailing Address - Street 2:URB. CAGUAX
Mailing Address - City:CAGUAS,
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:939-640-2346
Mailing Address - Fax:
Practice Address - Street 1:5800 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5583
Practice Address - Country:US
Practice Address - Phone:787-263-5166
Practice Address - Fax:787-263-0081
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist