Healthcare Provider Details

I. General information

NPI: 1366620809
Provider Name (Legal Business Name): MAXIMO RAMON TIRADOR SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95TH ST NORTH SHORE MEDICAL CENTER
MIAMI FL
33150-2038
US

IV. Provider business mailing address

6440 NW 114TH AVE UNIT 405
DORAL FL
33178-4572
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-6000
  • Fax:
Mailing address:
  • Phone: 305-905-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: