Provider Demographics
NPI:1942593850
Name:REINA, SUSAN JOYCE PADILLA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOYCE PADILLA
Last Name:REINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOYCE
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 N THUNDERBIRD CIR STE 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1218
Mailing Address - Country:US
Mailing Address - Phone:480-289-7890
Mailing Address - Fax:
Practice Address - Street 1:1701 E THOMAS RD
Practice Address - Street 2:STE A104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7646
Practice Address - Country:US
Practice Address - Phone:602-277-5998
Practice Address - Fax:602-277-9360
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant