Provider Demographics
NPI:1144265562
Name:PRADERIO, NESTOR HUGO (MD)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:HUGO
Last Name:PRADERIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 SANTA FE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2290
Mailing Address - Country:US
Mailing Address - Phone:361-887-9600
Mailing Address - Fax:361-883-1661
Practice Address - Street 1:1315 SANTA FE ST STE 201
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2290
Practice Address - Country:US
Practice Address - Phone:361-887-9600
Practice Address - Fax:361-883-1661
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ71392084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1169468-02Medicaid
TX80X500Medicare PIN
TXF18183Medicare UPIN