Provider Demographics
NPI:1285842880
Name:TIRADO-MENENDEZ, ANA MARIE
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIE
Last Name:TIRADO-MENENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ARAGON #2
Mailing Address - Street 2:TERRALINDA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-568-3255
Mailing Address - Fax:
Practice Address - Street 1:BAXTER
Practice Address - Street 2:CAPARRA HEIGHT STATION
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-2131
Practice Address - Country:US
Practice Address - Phone:787-568-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1905581OtherDRIVER LICENSE
PR4326OtherPHARMACIST LICENSE