Provider Demographics
NPI:1073503850
Name:RODRIGUEZ-PADILLA, MYRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:
Last Name:RODRIGUEZ-PADILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 270
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7873
Mailing Address - Country:US
Mailing Address - Phone:520-229-2578
Mailing Address - Fax:520-229-2561
Practice Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 270
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7873
Practice Address - Country:US
Practice Address - Phone:520-229-2578
Practice Address - Fax:520-229-2561
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8528012Medicaid
AZ803454Medicaid
AZP00083212OtherRAILROAD
NM8528012Medicaid
AZ77605Medicare ID - Type Unspecified