Healthcare Provider Details

I. General information

NPI: 1962036285
Provider Name (Legal Business Name): TAMMY ELIZABETH PRADO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 150
NEWBURY PARK CA
91320-6438
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-8705
US

V. Phone/Fax

Practice location:
  • Phone: 805-498-3640
  • Fax: 805-498-3641
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: