Provider Demographics
NPI:1467771733
Name:PRADO, MARIA VERONICA (LD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:VERONICA
Last Name:PRADO
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12470 STARCREST DR
Mailing Address - Street 2:APT 817
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8503
Mailing Address - Country:US
Mailing Address - Phone:210-403-2677
Mailing Address - Fax:
Practice Address - Street 1:12470 STARCREST DR
Practice Address - Street 2:APT 817
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8503
Practice Address - Country:US
Practice Address - Phone:210-403-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80111133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education