Provider Demographics
NPI:1235180001
Name:PADILLA, ALVARO (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 CENTRAL PARK BLVD N
Mailing Address - Street 2:STE 400
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1705
Mailing Address - Country:US
Mailing Address - Phone:561-288-5548
Mailing Address - Fax:561-482-1469
Practice Address - Street 1:4925 SHERIDAN ST
Practice Address - Street 2:STE 200
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2829
Practice Address - Country:US
Practice Address - Phone:954-981-3850
Practice Address - Fax:954-981-3889
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME957012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11564692OtherCAQH #