Provider Demographics
NPI:1336491125
Name:CUADRADO, PATRICIA DEANA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DEANA
Last Name:CUADRADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 E. LONGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007
Mailing Address - Country:US
Mailing Address - Phone:719-214-1272
Mailing Address - Fax:
Practice Address - Street 1:44 E. SPAULDING AVE.
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:719-214-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7146208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice