Healthcare Provider Details

I. General information

NPI: 1629602594
Provider Name (Legal Business Name): LAURA PRADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 406
HONOLULU HI
96813-2412
US

IV. Provider business mailing address

1951 SW 172ND AVE STE 305
MIRAMAR FL
33029-5614
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-7779
  • Fax:
Mailing address:
  • Phone: 954-362-2720
  • Fax: 954-362-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1190
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: