| Doctor Name: | STEPHANIE MARIE PRADO |
| NPI Number: | 1649344391 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | K9153 |
| Business Practice Address: | 1907 Highway 97 E Suite 130 Jourdanton, TX - 780261537 |
| Business Phone Number: | 8307695919 |
| Business Fax Number: | 9044463013 |
| Mailing Address: | Po Box 848510, BOSTON |
| State: | MA |
| Postal Code: | 022848510 |
| Phone Number: | 9044463451 |
| Fax Number: | 9044463013 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 01/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | K9153 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |