Provider Demographics
NPI:1386387132
Name:PRADO, IRIS AZUCENA
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:AZUCENA
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 1:36522 CANASTO CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-5854
Mailing Address - Country:US
Mailing Address - Phone:818-300-3048
Mailing Address - Fax:
Practice Address - Street 1:36522 CANASTO CT
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-5854
Practice Address - Country:US
Practice Address - Phone:818-300-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider