=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235006289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUGUSTO E TIRADO MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10181 PINES BLVD
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-798-7096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8330 SW 66TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-798-7096
-----------------------------------------------------
Fax | 305-798-7096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AUGUSTO ENRIQUE TIRADO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-798-7096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------