1740401512 NPI number — DR. SONIA N. GRAJALES-TIRADO D.

Table of content: DR. SONIA N. GRAJALES-TIRADO D. (NPI 1740401512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740401512 NPI number — DR. SONIA N. GRAJALES-TIRADO D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAJALES-TIRADO
Provider First Name:
SONIA
Provider Middle Name:
N.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740401512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A11 CALLE CORAL
Provider Second Line Business Mailing Address:
MANSIONES DE SANTA BARBARA
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-5108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-7310
Provider Business Mailing Address Fax Number:
787-653-7310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 CALLE ACOSTA
Provider Second Line Business Practice Location Address:
EDIFICIO YSERN, SUITE 313
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-7310
Provider Business Practice Location Address Fax Number:
787-653-7310
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1856 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3299 . This is a "APS HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 101584 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 579033 . This is a "FHC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: A 173 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 219134 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2325855 . This is a "CIGNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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