Provider Demographics
NPI:1811257397
Name:DR. RADAMES TIRADO, PSC
Entity type:Organization
Organization Name:DR. RADAMES TIRADO, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RADAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-439-1306
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0190
Mailing Address - Country:US
Mailing Address - Phone:787-439-1306
Mailing Address - Fax:787-831-7173
Practice Address - Street 1:32 CALLE DEL RIO N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4881
Practice Address - Country:US
Practice Address - Phone:787-831-7173
Practice Address - Fax:787-831-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
PR9191208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty