Provider Demographics
NPI:1003087099
Name:MARIO M. PADILLA, M.D., P.A.
Entity Type:Organization
Organization Name:MARIO M. PADILLA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:MARCOS
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:915-577-9090
Mailing Address - Street 1:1300 MUCHISON DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-577-9090
Mailing Address - Fax:915-577-9092
Practice Address - Street 1:1300 MURCHISON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4842
Practice Address - Country:US
Practice Address - Phone:915-577-9090
Practice Address - Fax:915-577-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98014Medicare UPIN
0048BDMedicare PIN