Provider Demographics
NPI:1578674891
Name:PADOVA, KARLA KRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:KRISTINE
Last Name:PADOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 E APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1904
Mailing Address - Country:US
Mailing Address - Phone:562-987-1819
Mailing Address - Fax:
Practice Address - Street 1:5266 E APPIAN WAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1904
Practice Address - Country:US
Practice Address - Phone:562-987-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP50318Medicare UPIN