Provider Demographics
NPI:1598256976
Name:PRADO, XIMENA ISABEL
Entity Type:Individual
Prefix:
First Name:XIMENA
Middle Name:ISABEL
Last Name:PRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VINE ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3642
Mailing Address - Country:US
Mailing Address - Phone:530-867-5395
Mailing Address - Fax:
Practice Address - Street 1:2725 YORI AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4325
Practice Address - Country:US
Practice Address - Phone:775-329-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2020-02-26
Deactivation Date:2019-08-09
Deactivation Code:
Reactivation Date:2020-02-26
Provider Licenses
StateLicense IDTaxonomies
CAF1623093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health