Provider Demographics
NPI:1518788496
Name:PRADO, KATHYRINE JOY A
Entity type:Individual
Prefix:
First Name:KATHYRINE JOY
Middle Name:A
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 1:94-419 KAHUALENA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3540
Mailing Address - Country:US
Mailing Address - Phone:808-425-7338
Mailing Address - Fax:
Practice Address - Street 1:94-419 KAHUALENA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3540
Practice Address - Country:US
Practice Address - Phone:808-425-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1220022376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide