Provider Demographics
NPI:1316012149
Name:PATRICK J. PADILLA, M.D. INC.
Entity Type:Organization
Organization Name:PATRICK J. PADILLA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-366-9899
Mailing Address - Street 1:55 CALLE CAREYES
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6997
Mailing Address - Country:US
Mailing Address - Phone:949-366-9899
Mailing Address - Fax:
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:SUITE #100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-633-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79160207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791600Medicaid
CA00G791600OtherBLUE SHIELD
CA00G791600OtherBLUE SHIELD
CA1315870001Medicare NSC