Basic Information
| Provider Information | |||||||||
| NPI: | 1851778179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIRADO | ||||||||
| FirstName: | GABRIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1960 CALLE ESPANA | ||||||||
| Address2: | URB OCEAN PARK | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009112101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874866495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 AVENIDAD PONCE DE LEON | ||||||||
| Address2: | NUTRITION DEPT. | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009091958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2015 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 132700000X | 1927 | PR | Y | Dietary & Nutritional Service Providers | Dietary Manager |
No ID Information.