Provider Demographics
NPI:1417653676
Name:PADILLA, JOSE RAMON
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 FOREST BEND D APT 303
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746
Mailing Address - Country:US
Mailing Address - Phone:786-491-8161
Mailing Address - Fax:
Practice Address - Street 1:7041 GRAND NATIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8380
Practice Address - Country:US
Practice Address - Phone:407-982-7718
Practice Address - Fax:407-704-5953
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator