Provider Demographics
NPI:1558912683
Name:LLANOS PADILLA, CARMEN D (MA, CPT, BHLTHSCI)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:D
Last Name:LLANOS PADILLA
Suffix:
Gender:F
Credentials:MA, CPT, BHLTHSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OLD BAY LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6135
Mailing Address - Country:US
Mailing Address - Phone:407-434-9208
Mailing Address - Fax:
Practice Address - Street 1:204 OLD BAY LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-6135
Practice Address - Country:US
Practice Address - Phone:407-434-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL640117190002246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy