Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11800 | PR |
NPI | 1235105495 |
---|---|
Provider Name | Antolin J Padilla |
First Address | Trujillo Alto, PR 00976 |
Second Address | Guaynabo, PR 00976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87730 | (05) | PR |
G41686 | (02) |