Provider Demographics
NPI:1801317805
Name:PADRON, VICTOR CECILIO (PA)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:CECILIO
Last Name:PADRON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16845 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-8439
Mailing Address - Country:US
Mailing Address - Phone:305-300-1212
Mailing Address - Fax:
Practice Address - Street 1:103 MEDICINE WAY ROAD
Practice Address - Street 2:
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6720363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical