Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 2002-0087 | NM |
NPI | 1336252063 |
---|---|
Provider Name | Mr. Luis Alfonso Padilla-Paz |
First Address | Albuquerque, NM 87109-2117 |
Second Address | Albuquerque, NM 87109-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G78393 | (02) | NM |