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General NPI Number Information
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NPI Number | 1902427503
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Entity Type | Individual
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Provider Name | GUILLERMO TIRADO SANTOS
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | KM 4.8 CARR 787 STE 2
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City | CIDRA
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State | PR
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Zip | 00739
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Country | US
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Telephone | 787-739-4624
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 CARR 787
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City | CIDRA
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State | PR
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Zip | 00739-2189
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23772
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License Number State | PR
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