Healthcare Provider Details

I. General information

NPI: 1235939307
Provider Name (Legal Business Name): MAGDALENA MIRANDA PRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 E CESAR E CHAVEZ AVE FL 2
LOS ANGELES CA
90022-1209
US

IV. Provider business mailing address

4701 E CESAR CHAVEZ AVE 2ND FLOOR
LOS ANGELES CA
90022
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-3400
  • Fax: 323-978-2371
Mailing address:
  • Phone: 323-267-3400
  • Fax: 323-978-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: