Provider Demographics
NPI:1780198077
Name:PRADO, CLAUDIA BERENICE
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:BERENICE
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 1:113 PLEASANT VALLEY DR
Mailing Address - Street 2:STE 210
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5683
Mailing Address - Country:US
Mailing Address - Phone:830-267-4575
Mailing Address - Fax:830-267-4575
Practice Address - Street 1:6487 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6104
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:210-334-2861
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily