Provider Demographics
NPI:1902835366
Name:PRADO, JULIO (PA)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:PRADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 SW 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3900
Mailing Address - Country:US
Mailing Address - Phone:954-442-7172
Mailing Address - Fax:954-442-7188
Practice Address - Street 1:6175 NW 153RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:305-558-9522
Practice Address - Fax:305-558-9520
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9100232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65401Medicare UPIN
FLE7884Medicare ID - Type Unspecified