Provider Demographics
NPI:1134235187
Name:PADILLA, JOSE A (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10666
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0666
Mailing Address - Country:US
Mailing Address - Phone:787-783-6620
Mailing Address - Fax:787-793-8444
Practice Address - Street 1:STREET 21 NUM. 1781
Practice Address - Street 2:HOSP. METROPOLITANO 1-FLOOR SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-783-6620
Practice Address - Fax:787-793-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8250207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR600084OtherMEDICARE Y MUCHO MAS
PR83349OtherBLUE SHIELD
PR3693OtherINTERNATIONAL MEDICAL CAR
PR069993OtherBLUE CROSS
PR83349Medicare ID - Type Unspecified
PRF93420Medicare UPIN