Provider Demographics
NPI:1700212271
Name:PRADO, CHARINALE ELORTA (NP)
Entity Type:Individual
Prefix:
First Name:CHARINALE
Middle Name:ELORTA
Last Name:PRADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHARINALE
Other - Middle Name:
Other - Last Name:ELORTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2466 W CRIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2578
Mailing Address - Country:US
Mailing Address - Phone:818-913-7235
Mailing Address - Fax:
Practice Address - Street 1:77 W FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-635-7307
Practice Address - Fax:928-774-3844
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner