Healthcare Provider Details

I. General information

NPI: 1013583442
Provider Name (Legal Business Name): DR. FRANCHESKA RACHELLE TIRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLAS DEL DEPORTIVO APT 106P
CABO ROJOS PR
00623
US

IV. Provider business mailing address

PO BOX 2652
SAN GERMAN PR
00683-2652
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-8038
  • Fax:
Mailing address:
  • Phone: 754-444-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6921
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6921
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6921
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerNONE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: