Healthcare Provider Details

I. General information

NPI: 1821534991
Provider Name (Legal Business Name): BRIANA PRADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 NW 1ST AVE
MIAMI FL
33127-4901
US

IV. Provider business mailing address

2015 NW 1ST AVE
MIAMI FL
33127-4901
US

V. Phone/Fax

Practice location:
  • Phone: 305-572-2026
  • Fax: 305-572-2025
Mailing address:
  • Phone: 305-572-2026
  • Fax: 305-572-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: