Provider Demographics
NPI:1184611980
Name:PADILLA, MARIO MARCOS (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:MARCOS
Last Name:PADILLA
Suffix:
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 1:1300 MURCHISON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-577-9090
Mailing Address - Fax:915-577-9092
Practice Address - Street 1:1300 MURCHISON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4842
Practice Address - Country:US
Practice Address - Phone:915-577-9090
Practice Address - Fax:915-577-9092
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7024174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80271FMedicare ID - Type Unspecified
0048BDMedicare PIN
C98014Medicare UPIN