Provider Demographics
NPI:1447726013
Name:PRADO, LEAH MARIE (RN)
Entity type:Individual
Prefix:
First Name:LEAH MARIE
Middle Name:
Last Name:PRADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8449 SUNSET ROSE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-7322
Mailing Address - Country:US
Mailing Address - Phone:951-310-2627
Mailing Address - Fax:
Practice Address - Street 1:14677 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:951-643-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2025-08-26
Deactivation Date:2023-12-04
Deactivation Code:
Reactivation Date:2023-12-22
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA699271164X00000X
CA95308815163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No164X00000XNursing Service ProvidersLicensed Vocational Nurse