Healthcare Provider Details

I. General information

NPI: 1063889624
Provider Name (Legal Business Name): ANGELINE MARIA PRADO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2015
Last Update Date: 08/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 SW 40TH ST
MIAMI FL
33165-3944
US

IV. Provider business mailing address

9980 SW 40TH ST
MIAMI FL
33165-3944
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-2255
  • Fax: 305-223-2622
Mailing address:
  • Phone: 305-223-2255
  • Fax: 305-223-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58296
License Number StateFL

VIII. Authorized Official

Name: DR. ANGELINE MARIA PRADO
Title or Position: PRESIDENT
Credential: MD
Phone: 305-223-2255