Healthcare Provider Details

I. General information

NPI: 1215385422
Provider Name (Legal Business Name): TIRADO INSTITUTE FOR CHRONIC CONDITIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 CROSS PARK DR
AUSTIN TX
78754-4595
US

IV. Provider business mailing address

4807 SPICEWOOD SPRINGS RD BLDG 2 STE 101
AUSTIN TX
78759-8444
US

V. Phone/Fax

Practice location:
  • Phone: 512-439-7360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL TIRADO
Title or Position: PRESIDENT
Credential: MD
Phone: 512-439-7360