Provider Demographics
NPI:1083473565
Name:PRADO, MARISOL (PARAMEDICAL ARTIST)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:PRADO
Suffix:
Gender:F
Credentials:PARAMEDICAL ARTIST
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:PRADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PARAMEDICAL ARTIST
Mailing Address - Street 1:2009 SEAGRAPE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7668
Mailing Address - Country:US
Mailing Address - Phone:520-313-8188
Mailing Address - Fax:
Practice Address - Street 1:2009 SEAGRAPE DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7668
Practice Address - Country:US
Practice Address - Phone:520-313-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57-44-2529132246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty