MEDICARE: MR. LUIS ALFONSO PADILLA-PAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	2002-0087	NM

General Provider Information

NPI Number	:	1336252063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS ALFONSO PADILLA-PAZ M.D.

Provider Business Mailing Address
First Line	:	4610 JEFFERSON LN NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2117
Country	:	US
Telephone Number	:	505-559-4495
Fax Number	:	505-842-8025

Provider Business Practice Location Address
First Line	:	4610 JEFFERSON LN NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2117
Country	:	US
Telephone Number	:	505-559-4495
Fax Number	:	505-842-8025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/06/2014

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