Basic Information
| Provider Information | |||||||||
| NPI: | 1447726013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRADO | ||||||||
| FirstName: | LEAH MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 DON LUIS CIR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928798216 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14677 MERRILL AVE | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516432340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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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 | 164X00000X | 699271 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.