Provider Demographics
NPI:1336617281
Name:PADERNA, THOMAS MARTIN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARTIN
Last Name:PADERNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 AYALA DR APT 105
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5535
Mailing Address - Country:US
Mailing Address - Phone:650-654-4565
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3074
Practice Address - Country:US
Practice Address - Phone:650-839-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program