Provider Demographics
NPI:1346204443
Name:PADILLA, DAMARIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMARIS
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 1:2060 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6123
Mailing Address - Country:US
Mailing Address - Phone:928-819-8999
Mailing Address - Fax:928-726-3799
Practice Address - Street 1:2060 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6123
Practice Address - Country:US
Practice Address - Phone:928-819-8999
Practice Address - Fax:928-726-3799
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ097992Medicaid