MEDICARE: GUAYNABO GERIATRIC CLINIC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1922940170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUAYNABO GERIATRIC CLINIC

Provider Business Mailing Address
First Line	:	67 CALLE CARAZO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5700
Country	:	US
Telephone Number	:	863-738-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 CALLE CARAZO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5700
Country	:	US
Telephone Number	:	863-738-3064
Fax Number	:

Authorized Official
Title or Position	:	MEDICO
Name	:	DR. ANTOLIN J PADILLA
Credential	:	MD
Telephone Number	:	863-738-3064

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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