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General NPI Number Information
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NPI Number | 1780502427
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Entity Type | Individual
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Provider Name | EIDA ENID ALTRECHE TIRADO LP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | SUITE 11 CENTRO ISABELINO DE MEDICINA AVANZADA (CIMA EM 112 KM 1.4 AVE. AGUSTIN RAMOS CALERO BO. MORA
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 787-932-0110
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Fax |
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Provider Business Mailing Address
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Address Line | SUITE 11 CENTRO ISABELINO DE MEDICINA AVANZADA (CIMA) 112 KM 1.4 AVE. AGUSTIN RAMOS CALERO
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 787-932-0110
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 007312
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License Number State | PR
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