Provider Demographics
NPI:1790386977
Name:PADILLA, GINA D
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:D
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 SAN PEDRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6727
Mailing Address - Country:US
Mailing Address - Phone:505-410-3445
Mailing Address - Fax:505-213-3298
Practice Address - Street 1:1307 SAN PEDRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6727
Practice Address - Country:US
Practice Address - Phone:505-410-3445
Practice Address - Fax:505-213-3298
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMBRC-2013-329933251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health