Provider Demographics
NPI:1669487153
Name:TIRADO, LUZ I (MT)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:I
Last Name:TIRADO
Suffix:
Gender:F
Credentials:MT
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 1353
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1353
Mailing Address - Country:US
Mailing Address - Phone:787-737-6042
Mailing Address - Fax:787-712-0540
Practice Address - Street 1:55 CALLE SANTIAGO N
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2426
Practice Address - Country:US
Practice Address - Phone:787-737-6042
Practice Address - Fax:787-712-0540
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2304246Z00000X
PR775246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
30979Medicare ID - Type UnspecifiedPROVEEDOR