Provider Demographics
NPI:1235512021
Name:PADILLA, ANGEL LUIS (VT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LUIS
Last Name:PADILLA
Suffix:
Gender:M
Credentials:VT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1659
Mailing Address - Country:US
Mailing Address - Phone:787-915-3030
Mailing Address - Fax:
Practice Address - Street 1:CARR. # 2 KM 7.6
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-915-3030
Practice Address - Fax:787-915-3033
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00072471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography