Provider Demographics
NPI:1891833240
Name:PADRO, ENRIQUE AGUSTIN I (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:AGUSTIN
Last Name:PADRO
Suffix:I
Gender:M
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:E17 CALLE MALAGA
Mailing Address - Street 2:VISTAMAR MARINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1507
Mailing Address - Country:US
Mailing Address - Phone:787-768-6661
Mailing Address - Fax:787-757-6935
Practice Address - Street 1:E17 CALLE MALAGA
Practice Address - Street 2:VISTAMAR MARINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1507
Practice Address - Country:US
Practice Address - Phone:787-768-6661
Practice Address - Fax:787-757-6935
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR66212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR78227Medicare UPIN
PR28325-AMedicare ID - Type Unspecified