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General NPI Number Information
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NPI Number | 1649344391
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE PRADO MD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 1907 HIGHWAY 97 E SUITE 130
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City | JOURDANTON
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State | TX
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Zip | 78026-1537
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Country | US
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Telephone | 830-769-5919
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Fax | 904-446-3013
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Provider Business Mailing Address
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Address Line | PO BOX 848510
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City | BOSTON
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State | MA
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Zip | 02284-8510
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Country | US
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Telephone | 904-446-3451
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Fax | 904-446-3013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K9153
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | K9153
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | K9153
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License Number State | TX
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