Provider Demographics
NPI:1669148300
Name:ROSA PADILLA, JOSE ABIMAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ABIMAEL
Last Name:ROSA PADILLA
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:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1096
Mailing Address - Country:US
Mailing Address - Phone:787-854-3851
Mailing Address - Fax:
Practice Address - Street 1:CALLE ELLIOT VELEZ
Practice Address - Street 2:URB. ATENAS J23
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty