Provider Demographics
NPI:1972848943
Name:PRADO, TIFFANY DAWN (LAC, DACM)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:DAWN
Last Name:PRADO
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DAWN
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:0110 SW BANCROFT ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4062
Mailing Address - Country:US
Mailing Address - Phone:971-225-0333
Mailing Address - Fax:888-958-3064
Practice Address - Street 1:0110 SW BANCROFT ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4062
Practice Address - Country:US
Practice Address - Phone:971-225-0333
Practice Address - Fax:888-958-3064
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist