Provider Demographics
NPI:1255428686
Name:TIRADO MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:TIRADO MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEIVYS
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-818-5960
Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:#314
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:#314
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:305-818-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies