Provider Demographics
NPI:1437114915
Name:PRADO, CRISTIAN DAVID (MOTRL, DPT, CHT)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:DAVID
Last Name:PRADO
Suffix:
Gender:M
Credentials:MOTRL, DPT, CHT
Other - Prefix:
Other - First Name:CRISTIAN
Other - Middle Name:D
Other - Last Name:PRADO CAPETILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTRL, DPT
Mailing Address - Street 1:CALLE GAVIOTA FF-8
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2309
Mailing Address - Country:US
Mailing Address - Phone:904-315-0394
Mailing Address - Fax:888-796-2874
Practice Address - Street 1:60 AVENIDA PONCE DE LEON
Practice Address - Street 2:TORRE AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5029
Practice Address - Country:US
Practice Address - Phone:904-315-0394
Practice Address - Fax:888-796-2874
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4548225100000X
FLPT26351225100000X
FLOT12243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00401533OtherRR MEDICARE
FLAD777YMedicare PIN
FLP00401533OtherRR MEDICARE