Healthcare Provider Details

I. General information

NPI: 1417384330
Provider Name (Legal Business Name): ALEXANDER TIRADO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date: 06/29/2021
Reactivation Date: 07/20/2021

III. Provider practice location address

20040 W DIXIE HWY APT 14302
AVENTURA FL
33180-1931
US

IV. Provider business mailing address

20040 W DIXIE HWY APT 14302
AVENTURA FL
33180-1931
US

V. Phone/Fax

Practice location:
  • Phone: 305-962-1789
  • Fax: 305-404-9530
Mailing address:
  • Phone: 305-962-1789
  • Fax: 305-404-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: