Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 58518 | AZ |
N | 2086S0120X | Pediatric Surgery | MT200160 | PA |
NPI | 1639458201 |
---|---|
Provider Name | Benjamin Padilla |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2011 |
Last Update Date | 09/08/2019 |