Provider Demographics
NPI:1114260601
Name:ORNELAS PRADO, LUZ (MD)
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:
Last Name:ORNELAS PRADO
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 1:20800 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2707
Mailing Address - Country:US
Mailing Address - Phone:818-883-2273
Mailing Address - Fax:
Practice Address - Street 1:20800 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2707
Practice Address - Country:US
Practice Address - Phone:818-883-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA133259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program