Provider Demographics
NPI:1508174798
Name:PADILLA, ELSIE L (LND)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:L
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 370161
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00737
Mailing Address - Country:UM
Mailing Address - Phone:787-263-6790
Mailing Address - Fax:787-263-6790
Practice Address - Street 1:#55
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00736
Practice Address - Country:UM
Practice Address - Phone:787-557-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1294133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist