Provider Demographics
NPI:1578114104
Name:PRADO, TARYN CELESTE (RD)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:CELESTE
Last Name:PRADO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15303 HUEBNER RD STE 15
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0983
Mailing Address - Country:US
Mailing Address - Phone:210-666-9905
Mailing Address - Fax:
Practice Address - Street 1:15303 HUEBNER RD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0983
Practice Address - Country:US
Practice Address - Phone:210-666-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85499133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal