Provider Demographics
NPI:1639876444
Name:GONZALEZ PRADO, DAMASO (ARNP FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DAMASO
Middle Name:
Last Name:GONZALEZ PRADO
Suffix:
Gender:M
Credentials:ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 W 44TH PL APT A103
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7454
Mailing Address - Country:US
Mailing Address - Phone:786-326-4371
Mailing Address - Fax:
Practice Address - Street 1:1975 W 44TH PL APT A103
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7454
Practice Address - Country:US
Practice Address - Phone:786-326-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily