Provider Demographics
NPI:1629116520
Name:PADILLA, RAYMOND M (PA-C)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4457 44TH AVE SW
Mailing Address - Street 2:#101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4906
Mailing Address - Country:US
Mailing Address - Phone:206-935-4850
Mailing Address - Fax:
Practice Address - Street 1:1901 S CEDAR ST
Practice Address - Street 2:#201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2308
Practice Address - Country:US
Practice Address - Phone:253-272-2261
Practice Address - Fax:253-627-9842
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA10002467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical