Provider Demographics
NPI:1366612756
Name:PRADO, ERNESTO J (MAT 9365)
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:J
Last Name:PRADO
Suffix:
Gender:M
Credentials:MAT 9365
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 NAPILIHAU ST
Mailing Address - Street 2:109-B PMB-116
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-8800
Mailing Address - Country:US
Mailing Address - Phone:808-214-0543
Mailing Address - Fax:
Practice Address - Street 1:2580 KEKAA DR
Practice Address - Street 2:S-110
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2908
Practice Address - Country:US
Practice Address - Phone:808-661-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-9365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist