Provider Demographics
NPI:1568439933
Name:PRADIA, LEE E JR (IDC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:E
Last Name:PRADIA
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 CARTAGENA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-3921
Mailing Address - Country:US
Mailing Address - Phone:361-961-6190
Mailing Address - Fax:
Practice Address - Street 1:10651 E ST
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5130
Practice Address - Country:US
Practice Address - Phone:361-961-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman