Provider Demographics
NPI:1720359482
Name:PADRON, VLADIMIR I (MA)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:I
Last Name:PADRON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1932
Mailing Address - Country:US
Mailing Address - Phone:305-281-0820
Mailing Address - Fax:305-388-2613
Practice Address - Street 1:21 NW 136TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1932
Practice Address - Country:US
Practice Address - Phone:305-281-0820
Practice Address - Fax:305-388-2613
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65506225700000X
FL11006721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty