Healthcare Provider Details

I. General information

NPI: 1508989831
Provider Name (Legal Business Name): DANIEL DEL PRADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE PUERTO RICO, BO MONACILLOS RADIOLOGIA RCM
SAN JUAN PR
00935
US

IV. Provider business mailing address

1770 IOWA AVE STE 280
RIVERSIDE CA
92507-7401
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-777-3858
Mailing address:
  • Phone: 951-786-0801
  • Fax: 787-777-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301089201
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17079
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: