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General NPI Number Information
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NPI Number | 1134947666
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Entity Type | Individual
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Provider Name | MR. JOSE ANTONIO TIRADO III
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Gender | Male
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 370 LINWOOD ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1998
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Country | US
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Telephone | 860-224-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 61 DONALD ST APT 3A
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City | HARTFORD
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State | CT
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Zip | 06120-2741
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Country | US
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Telephone | 860-794-8893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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