Provider Demographics
NPI:1952687436
Name:PADILLA, DEBBIE DIMAS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:DIMAS
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:DIMAS
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3802 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2368
Mailing Address - Country:US
Mailing Address - Phone:623-772-2290
Mailing Address - Fax:623-877-3717
Practice Address - Street 1:3802 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2368
Practice Address - Country:US
Practice Address - Phone:623-772-2290
Practice Address - Fax:623-877-3717
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP031820164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse