Provider Demographics
NPI:1689829210
Name:PADILLA, LUCIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:LUCIA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 E VERNON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3772
Mailing Address - Country:US
Mailing Address - Phone:323-233-9686
Mailing Address - Fax:323-233-0595
Practice Address - Street 1:1061 E VERNON AVE STE F
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3772
Practice Address - Country:US
Practice Address - Phone:323-233-9686
Practice Address - Fax:323-233-0595
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1085622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1085622Medicaid