Provider Demographics
NPI:1093879082
Name:PADILLA, MACARIA
Entity Type:Individual
Prefix:
First Name:MACARIA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24578 SUNNYMEAD BLVD
Mailing Address - Street 2:#B
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:951-601-2260
Mailing Address - Fax:951-601-2261
Practice Address - Street 1:24578 SUNNYMEAD BLVD
Practice Address - Street 2:#B
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-601-2260
Practice Address - Fax:951-601-2261
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3854260001Medicare NSC