Healthcare Provider Details

I. General information

NPI: 1003728130
Provider Name (Legal Business Name): MICHAEL PADILLA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 S I 19 FRONTAGE RD STE 139
GREEN VALLEY AZ
85614-6338
US

IV. Provider business mailing address

PO BOX 2341
TUBAC AZ
85646-2341
US

V. Phone/Fax

Practice location:
  • Phone: 520-407-5910
  • Fax:
Mailing address:
  • Phone: 520-406-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number345949
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: