Healthcare Provider Details

I. General information

NPI: 1780159830
Provider Name (Legal Business Name): YANIRA TIRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 MOCA DR
SAINT CLOUD FL
34772-8148
US

IV. Provider business mailing address

3642 MOCA DR
SAINT CLOUD FL
34772-8148
US

V. Phone/Fax

Practice location:
  • Phone: 407-666-1129
  • Fax: 407-483-9551
Mailing address:
  • Phone: 407-666-1129
  • Fax: 407-483-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: