Provider Demographics
NPI:1134947666
Name:TIRADO, JOSE ANTONIO III
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:TIRADO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DONALD ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2741
Mailing Address - Country:US
Mailing Address - Phone:860-794-8893
Mailing Address - Fax:
Practice Address - Street 1:370 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1998
Practice Address - Country:US
Practice Address - Phone:860-224-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program