Provider Demographics
NPI:1750300802
Name:PADILLA, OLGA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8165 AVE JOBOS
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2232
Mailing Address - Country:US
Mailing Address - Phone:787-475-7816
Mailing Address - Fax:787-830-6767
Practice Address - Street 1:8165 AVE JOBOS
Practice Address - Street 2:SUITE # 2
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2232
Practice Address - Country:US
Practice Address - Phone:787-475-7816
Practice Address - Fax:787-830-6767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14960208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021897ZOtherMEDICARE PTAN
PRH98270Medicare UPIN