Provider Demographics
NPI:1932263928
Name:PADILLAS, EZEQUIEL
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:PADILLAS
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 1:24183 POSTAL AVE # 7
Mailing Address - Street 2:AP MOBILITY
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3071
Mailing Address - Country:US
Mailing Address - Phone:951-488-9327
Mailing Address - Fax:951-488-9328
Practice Address - Street 1:24183 POSTAL AVE # 7
Practice Address - Street 2:AP MOBILITY
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3071
Practice Address - Country:US
Practice Address - Phone:951-488-9327
Practice Address - Fax:951-488-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy