Provider Demographics
NPI:1659917201
Name:PRADO, MADELINE (NP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PRADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:MARROQUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2151 RISDON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 CROW CANYON PL STE C
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1359
Practice Address - Country:US
Practice Address - Phone:925-202-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017187363LF0000X
CA95066604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse