Provider Demographics
NPI:1295839793
Name:PADILLA, DENISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISSE
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
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:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-630-3288
Mailing Address - Fax:787-254-0034
Practice Address - Street 1:#73 MUNOZ RIVERA STREET
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-254-0034
Practice Address - Fax:787-254-0034
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15106208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22921Medicare UPIN
PR0022879Medicare ID - Type Unspecified