Provider Demographics
NPI:1376304667
Name:PRADO, JASMINE M
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:PRADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 40TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7215
Mailing Address - Country:US
Mailing Address - Phone:708-831-1705
Mailing Address - Fax:
Practice Address - Street 1:2424 40TH AVE APT 6
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7215
Practice Address - Country:US
Practice Address - Phone:708-831-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program