Provider Demographics
NPI:1205041670
Name:PADILLA, DIANA (BSPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:VILMA
Other - Middle Name:
Other - Last Name:NAVEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSPH
Mailing Address - Street 1:PO BOX 364708
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4708
Mailing Address - Country:US
Mailing Address - Phone:787-758-8383
Mailing Address - Fax:787-754-9657
Practice Address - Street 1:550 SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:787-754-9657
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist