MEDICARE: JAVIER M PRADO MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	ME82500	FL
2	2084P0800X	Psychiatry Physician	ME82500	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	:	1922148253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER M PRADO MD

Provider Business Mailing Address
First Line	:	827 18TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6481
Country	:	US
Telephone Number	:	772-925-8200
Fax Number	:	772-925-8199

Provider Business Practice Location Address
First Line	:	725 N US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9125
Country	:	US
Telephone Number	:	772-252-4014
Fax Number	:	772-999-5577

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	05/30/2024

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Directions to “ JAVIER M PRADO MD” Practice Location

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