Healthcare Provider Details

I. General information

NPI: 1962818591
Provider Name (Legal Business Name): AIDA TIRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

IV. Provider business mailing address

703 DESTINY LN
SAN RAMON CA
94583-1955
US

V. Phone/Fax

Practice location:
  • Phone: 925-813-6500
  • Fax:
Mailing address:
  • Phone: 818-740-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number180388
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA146202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: