Provider Demographics
NPI:1225158546
Name:PRADO, HEIDI K (PA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:K
Last Name:PRADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3270
Mailing Address - Country:US
Mailing Address - Phone:559-781-1665
Mailing Address - Fax:
Practice Address - Street 1:590 W PUTNAM AVE
Practice Address - Street 2:2A
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-781-4100
Practice Address - Fax:559-781-4350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17970OtherPHYSICIAN ASSISTANT LICEN