Provider Demographics
NPI:1043272602
Name:PADILLA, DIANA M (MS, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MS, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-0001
Mailing Address - Country:US
Mailing Address - Phone:480-965-9430
Mailing Address - Fax:480-965-8224
Practice Address - Street 1:500 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0001
Practice Address - Country:US
Practice Address - Phone:480-965-9430
Practice Address - Fax:480-965-8224
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0833OtherAZ STATE BOARD OF ATHLETIC TRAINING
020402087OtherNATIONAL ATHLETIC TRAINERS' BOARD OF CERTIFICATION
ORAT-AT-10112912OtherOREGON HEALTH LICENSING