Basic Information
| Provider Information | |||||||||
| NPI: | 1124568662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALAVECINO-PRADO | ||||||||
| FirstName: | BERNADITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1663 MISSION ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772646747 | ||||||||
| FaxNumber: | 8775397730 | ||||||||
| Practice Location | |||||||||
| Address1: | 871 COLEMAN AVE STE 209 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951101831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772646747 | ||||||||
| FaxNumber: | 8775397730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2017 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | RBT-16-22368 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.