Provider Demographics
NPI:1174178677
Name:PRADO, JACLYN RENEE
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:RENEE
Last Name:PRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JACLYN
Other - Middle Name:RENEE
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 E COLORADO BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2380
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:5400 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5614
Practice Address - Country:US
Practice Address - Phone:915-777-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician