MEDICARE: DR. GUILLERMO J TIRADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	10402	PR

General Provider Information

NPI Number	:	1629087473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO J TIRADO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7303
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-7303
Country	:	US
Telephone Number	:	787-739-9495
Fax Number	:	787-296-9767

Provider Business Practice Location Address
First Line	:	140 CALLE JOSE DE DIEGO
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-3227
Country	:	US
Telephone Number	:	787-739-9495
Fax Number	:	787-296-9767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	01/05/2011

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