Provider Demographics
NPI:1831641752
Name:PEREZ-PRADO, ZINIA M
Entity Type:Individual
Prefix:DR
First Name:ZINIA
Middle Name:M
Last Name:PEREZ-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:F3 CALLE 5
Mailing Address - Street 2:URB SAN ANTONIO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 AVE RAFAEL CORDERO
Practice Address - Street 2:PLAZA DEL MERCADO, OFICINA 7
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3811
Practice Address - Country:US
Practice Address - Phone:787-349-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3021103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist