Healthcare Provider Details

I. General information

NPI: 1285660373
Provider Name (Legal Business Name): CARLOS A BUXO TIRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Y38 BOULEVARD MONROIG CUARTA SECCION LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 51519
TOA BAJA PR
00950-1519
US

V. Phone/Fax

Practice location:
  • Phone: 787-200-0324
  • Fax: 787-200-0325
Mailing address:
  • Phone: 787-200-0324
  • Fax: 787-200-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14329
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: