1083709273 NPI number — MRS. MARTHA ELIZABETH PADILLA ARNP

Table of content: MRS. MARTHA ELIZABETH PADILLA ARNP (NPI 1083709273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083709273 NPI number — MRS. MARTHA ELIZABETH PADILLA ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADILLA
Provider First Name:
MARTHA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083709273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI SHORES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33138-4276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-759-8532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NW 16TH STREET,
Provider Second Line Business Practice Location Address:
112
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-575-7000
Provider Business Practice Location Address Fax Number:
305-575-3255
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  1651912 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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