Provider Demographics
NPI:1558376236
Name:PRADO, ANGELINE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINE
Middle Name:MARIA
Last Name:PRADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3044
Mailing Address - Country:US
Mailing Address - Phone:305-667-4795
Mailing Address - Fax:
Practice Address - Street 1:9980 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3944
Practice Address - Country:US
Practice Address - Phone:305-223-2255
Practice Address - Fax:305-223-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE94371Medicare UPIN