Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 264376 | AZ |
NPI | 1205599511 |
---|---|
Provider Name | Heather Marie Padilla |
First Address | Yuma, AZ 85365-4867 |
Second Address | Yuma, AZ 85365-4867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2021 |
Last Update Date | 14/10/2021 |