Provider Demographics
NPI:1912698978
Name:PRADO, LETICIA MARIE
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MARIE
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 1:875 N ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-3002
Mailing Address - Country:US
Mailing Address - Phone:559-595-1341
Mailing Address - Fax:559-595-1346
Practice Address - Street 1:875 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3002
Practice Address - Country:US
Practice Address - Phone:559-595-1341
Practice Address - Fax:559-595-1346
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79123183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician