1962601633 NPI number — KATHERINE MARIE PADILLA-RODRIGUEZ M.D.

Table of content: KATHERINE MARIE PADILLA-RODRIGUEZ M.D. (NPI 1962601633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962601633 NPI number — KATHERINE MARIE PADILLA-RODRIGUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADILLA-RODRIGUEZ
Provider First Name:
KATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1962601633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DA-3 CALLE HASTINGS
Provider Second Line Business Mailing Address:
GARDEN HILLS NORTE
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-5060
Provider Business Mailing Address Fax Number:
787-653-9880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CALLE PADIAL STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-5060
Provider Business Practice Location Address Fax Number:
787-653-9880
Provider Enumeration Date:
07/13/2007

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: 2084N0400X , with the licence number:  17,907 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 17907 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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