Provider Demographics
NPI:1396358370
Name:PADILLA VILLAR, CARLOS (NP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PADILLA VILLAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3409
Mailing Address - Country:US
Mailing Address - Phone:562-595-7467
Mailing Address - Fax:
Practice Address - Street 1:3760 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3409
Practice Address - Country:US
Practice Address - Phone:562-595-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF08200776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF08200776OtherFNP CERTIFICATION NO