Provider Demographics
NPI:1265421119
Name:VILMA I PADILLA PADILLA/LAB CLINICO ROYAL GARDENS
Entity type:Organization
Organization Name:VILMA I PADILLA PADILLA/LAB CLINICO ROYAL GARDENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:PADILLA
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-279-4446
Mailing Address - Street 1:CALLE ESTHER E-4 ROYAL GARDENS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-279-4446
Mailing Address - Fax:787-279-6428
Practice Address - Street 1:CALLE ESTHER E-4 ROYAL GARDENS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-279-4446
Practice Address - Fax:787-279-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30785Medicare ID - Type Unspecified