Provider Demographics
NPI:1649423245
Name:PADILLA, EVELYN TANIG (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:EVELYN
Middle Name:TANIG
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18945 FM 2252,
Mailing Address - Street 2:STE 115
Mailing Address - City:GARDEN RIDGE,
Mailing Address - State:TX
Mailing Address - Zip Code:78266
Mailing Address - Country:US
Mailing Address - Phone:210-651-0027
Mailing Address - Fax:210-651-0029
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:SUITE115
Practice Address - City:GARDEN RIDGE,
Practice Address - State:TX
Practice Address - Zip Code:78266
Practice Address - Country:US
Practice Address - Phone:210-651-0027
Practice Address - Fax:210-651-0029
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286500000X286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital