Provider Demographics
NPI:1457338048
Name:PADILLA LOPEZ, EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:PADILLA LOPEZ
Suffix:
Gender:F
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:PO BOX 52324
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2324
Mailing Address - Country:US
Mailing Address - Phone:787-795-1025
Mailing Address - Fax:
Practice Address - Street 1:3175 DEL VALLE AVE
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-1025
Practice Address - Fax:787-784-2490
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11503208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR500029EOtherMEDICARE Y MUCHO MAS
PR84636OtherTRIPLE S PROVIDER NUMBER
PR201693OtherPREFERRED HEALTH NUMBER
PR8298OtherFIRST MEDICAL HEALTH PLAN
PR11503OtherUIA HEALTH PLAN
PR111503OtherMCS HEALTH PLAN
PR11503OtherCIGNA HEALTH PLAN
PR500029EOtherMEDICARE Y MUCHO MAS
PR0080057OtherCRUZ AZUL DE PR PROVIDER
PRG42900Medicare UPIN