Individual
STEPHANIE MARIE PRADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1907 HIGHWAY 97 E, SUITE 130, JOURDANTON, TX 78026-1537
(830) 769-5919
(904) 446-3013
Mailing address
PO BOX 848510, BOSTON, MA 02284-8510
(904) 446-3451
(904) 446-3013
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
K9153
TX
208100000X
Physical Medicine & Rehabilitation Physician
K9153
TX
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
K9153
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010915507
TAX ID
TX
Enumeration date
11/17/2006
Last updated
12/01/2021
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