Healthcare Provider Details

I. General information

NPI: 1750303590
Provider Name (Legal Business Name): RAFAEL CRUZ-TIRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 CALLE FERNANDO L GARCIA
UTUADO PR
00641-3068
US

IV. Provider business mailing address

PO BOX 609
UTUADO PR
00641-0609
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-1160
  • Fax:
Mailing address:
  • Phone: 787-894-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6601
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: