Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 011694 | PR |
Y | 207QA0505X | Family Doctor - Adult Medicine | ACN119 | FL |
NPI | 1265784144 |
---|---|
Provider Name | Pascasio L Lopez-Padilla |
First Address | Orlando, FL 32878-0165 |
Second Address | Orlando, FL 32831-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 03/10/2012 |