1235753013 NPI number — MRS. IRENE C PADIN PHD, CLINICAL THAN.

Table of content: MRS. IRENE C PADIN PHD, CLINICAL THAN. (NPI 1235753013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235753013 NPI number — MRS. IRENE C PADIN PHD, CLINICAL THAN.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADIN
Provider First Name:
IRENE
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD, CLINICAL THAN.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PADIN
Provider Other First Name:
IRENE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
THANATOLOGIST, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235753013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 AVENIDA LUIS MUNOZ RIVERA
Provider Second Line Business Mailing Address:
PLAZA LEONARDO AVILES
Provider Business Mailing Address City Name:
CAMUY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 AVENIDA LUIS MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
CENTRO PLAZA LEONARDO AVILES
Provider Business Practice Location Address City Name:
CAMUY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-599-1041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2020

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: 174400000X , with the licence number:  THANATOLOGY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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