Provider Demographics
NPI:1902266810
Name:OLGA PRADA MD MEDICAL CLINIC CORP
Entity Type:Organization
Organization Name:OLGA PRADA MD MEDICAL CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADA-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-267-1705
Mailing Address - Street 1:720 SW 58TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3928
Mailing Address - Country:US
Mailing Address - Phone:305-267-1705
Mailing Address - Fax:305-267-1703
Practice Address - Street 1:720 SW 58TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3928
Practice Address - Country:US
Practice Address - Phone:305-267-1705
Practice Address - Fax:305-267-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty