Provider Demographics
NPI:1366160897
Name:PRADO, MARYAH NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:MARYAH
Middle Name:NICOLE
Last Name:PRADO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12747 SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2215
Mailing Address - Country:US
Mailing Address - Phone:818-741-8708
Mailing Address - Fax:
Practice Address - Street 1:13101 HARTFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1511
Practice Address - Country:US
Practice Address - Phone:858-259-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant