Provider Demographics
NPI:1750445813
Name:PADILLA, JOSE ALFREDO SR (PHTC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALFREDO
Last Name:PADILLA
Suffix:SR
Gender:M
Credentials:PHTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ELIZABETH EXODO ST. 5074
Mailing Address - Street 2:PUERTO REAL
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4970
Mailing Address - Country:US
Mailing Address - Phone:787-851-1250
Mailing Address - Fax:
Practice Address - Street 1:5074 CALLE EXODO
Practice Address - Street 2:EXTENSION ELIZABETH
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4970
Practice Address - Country:US
Practice Address - Phone:787-851-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006038183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician