Healthcare Provider Details

I. General information

NPI: 1043272602
Provider Name (Legal Business Name): DIANA M PADILLA MS, ATC, EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VETERANS WAY
TEMPE AZ
85287-0001
US

IV. Provider business mailing address

500 VETERANS WAY
TEMPE AZ
85287-0001
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-9430
  • Fax: 480-965-8224
Mailing address:
  • Phone: 480-965-9430
  • Fax: 480-965-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number373
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: