Provider Demographics
NPI:1235901661
Name:PADILLA, PATRICIA DIANE (MSN, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S IMPERIAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-339-2802
Mailing Address - Fax:
Practice Address - Street 1:1600 S IMPERIAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:760-339-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily