1700183985 NPI number — ALEXANDER J PADILLA LSA

Table of content: ALEXANDER J PADILLA LSA (NPI 1700183985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700183985 NPI number — ALEXANDER J PADILLA LSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADILLA
Provider First Name:
ALEXANDER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSA
Provider Gender Code:
M

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:
1700183985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9119 GLENFAIR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77379-3743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-426-3023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9119 GLENFAIR CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-426-3023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2011

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: 363AS0400X , with the licence number:  CSA-08108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: SA-0130 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SA0130 . This is a "STATE LICENCE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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