Provider Demographics
NPI:1285149773
Name:PRADO, HEIDI ANN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:PRADO
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:PO BOX 71182
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96079-1182
Mailing Address - Country:US
Mailing Address - Phone:530-355-7375
Mailing Address - Fax:530-338-2188
Practice Address - Street 1:1700 MARKET ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1932
Practice Address - Country:US
Practice Address - Phone:530-355-7375
Practice Address - Fax:530-338-2188
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier