Provider Demographics
NPI:1316199516
Name:PADILLA DAVILA, VANESSA L (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:PADILLA DAVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESA
Other - Middle Name:L
Other - Last Name:PADILLA DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-355-8260
Mailing Address - Fax:305-355-7266
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-355-8260
Practice Address - Fax:305-355-7266
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112707390200000X, 2084N0400X
PR179332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry