1447444377 NPI number — BERLINDA A PADILLA-OTTO PA

Table of content: BERLINDA A PADILLA-OTTO PA (NPI 1447444377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447444377 NPI number — BERLINDA A PADILLA-OTTO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADILLA-OTTO
Provider First Name:
BERLINDA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1447444377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SW 10TH AVE
Provider Second Line Business Mailing Address:
DIABETES SUPPORT SERVICES
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-354-5598
Provider Business Mailing Address Fax Number:
785-354-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SW 10TH AVE.
Provider Second Line Business Practice Location Address:
DIABETES SUPPORT SERVICES
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-354-5598
Provider Business Practice Location Address Fax Number:
785-354-5396
Provider Enumeration Date:
09/04/2007

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: 363A00000X , with the licence number:  15-01893 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201135850A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 068002374 . This is a "MEDICARE-PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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