Provider Demographics
NPI:1245258136
Name:PADRE, EMILIO JAMORABON (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:JAMORABON
Last Name:PADRE
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 1:282 E SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6323
Mailing Address - Country:US
Mailing Address - Phone:310-518-6861
Mailing Address - Fax:310-835-1366
Practice Address - Street 1:282 E SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6323
Practice Address - Country:US
Practice Address - Phone:310-518-6861
Practice Address - Fax:310-835-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37011208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84947Medicare UPIN