Provider Demographics
NPI:1104374842
Name:LAFOURCADE PRADA, ZADDY (MD)
Entity Type:Individual
Prefix:
First Name:ZADDY
Middle Name:
Last Name:LAFOURCADE PRADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:5961 NW 173RD DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5114
Practice Address - Country:US
Practice Address - Phone:305-556-7500
Practice Address - Fax:305-851-5708
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14,149-I208D00000X
FLME144049208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice