Healthcare Provider Details

I. General information

NPI: 1538307186
Provider Name (Legal Business Name): BERNARDITA PRADO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 06/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ATLANTIC BLVD
JACKSONVILLE FL
32207-2038
US

IV. Provider business mailing address

2396 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3764
  • Fax:
Mailing address:
  • Phone: 904-781-2300
  • Fax: 904-781-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 9667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: