Provider Demographics
NPI:1740401512
Name:GRAJALES-TIRADO, SONIA N (D)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:N
Last Name:GRAJALES-TIRADO
Suffix:
Gender:F
Credentials:D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A11 CALLE CORAL
Mailing Address - Street 2:MANSIONES DE SANTA BARBARA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5108
Mailing Address - Country:US
Mailing Address - Phone:787-653-7310
Mailing Address - Fax:787-653-7310
Practice Address - Street 1:32 CALLE ACOSTA
Practice Address - Street 2:EDIFICIO YSERN, SUITE 313
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-7310
Practice Address - Fax:787-653-7310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3299OtherAPS HUMANA
PR101584OtherCRUZ AZUL
PR579033OtherFHC
PRA 173OtherFIRST MEDICAL
PR219134OtherPREFERRED HEALTH
PR2325855OtherCIGNA