MEDICARE: JULIO PRADO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 9100232	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902835366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIO PRADO PA

Provider Business Mailing Address
First Line	:	104 SW 180TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-3900
Country	:	US
Telephone Number	:	954-442-7172
Fax Number	:	954-442-7188

Provider Business Practice Location Address
First Line	:	6175 NW 153RD ST
Second Line	:	SUITE 301
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2435
Country	:	US
Telephone Number	:	305-558-9522
Fax Number	:	305-558-9520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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Directions to “ JULIO PRADO PA” Practice Location

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