Provider Demographics
NPI:1194922948
Name:RODRIGUEZ PRADO, YAHDIRA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:YAHDIRA
Middle Name:MARIE
Last Name:RODRIGUEZ PRADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:407-650-7129
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S ORANGE AVE SUITE 100
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17072208000000X, 2080N0001X
FLME1148512080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics