Healthcare Provider Details

I. General information

NPI: 1780502427
Provider Name (Legal Business Name): EIDA ENID ALTRECHE TIRADO LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 11 CENTRO ISABELINO DE MEDICINA AVANZADA (CIMA EM 112 KM 1.4 AVE. AGUSTIN RAMOS CALERO BO. MORA
ISABELA PR
00662
US

IV. Provider business mailing address

SUITE 11 CENTRO ISABELINO DE MEDICINA AVANZADA (CIMA) 112 KM 1.4 AVE. AGUSTIN RAMOS CALERO
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-932-0110
  • Fax:
Mailing address:
  • Phone: 787-932-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007312
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: