MEDICARE: ITZEL PADRON MSW

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	1041C0700X	Clinical Social Worker	ISW11860	FL

General Provider Information

NPI Number	:	1538697958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITZEL PADRON MSW

Provider Business Mailing Address
First Line	:	2658 W 74TH TER
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-5431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2658 W 74TH TER
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	786-389-9094
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	06/05/2018

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