Provider Demographics
NPI:1750007126
Name:TIRADO DAVILA, HECTOR ANTONIO SR (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:ANTONIO
Last Name:TIRADO DAVILA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO RIVERSIDE PLAZA
Mailing Address - Street 2:CALLE SANTA CRUZ NUMERO 74 APT 15-B
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7077
Mailing Address - Country:US
Mailing Address - Phone:939-496-5050
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO RIVERSIDE PLAZA
Practice Address - Street 2:CALLE SANTA CRUZ NUMERO 74 APT 15-B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7077
Practice Address - Country:US
Practice Address - Phone:939-496-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23183208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice