Healthcare Provider Details

I. General information

NPI: 1689829210
Provider Name (Legal Business Name): LUCIA PADILLA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E VERNON AVE STE F
LOS ANGELES CA
90011-3772
US

IV. Provider business mailing address

1061 E VERNON AVE STE F
LOS ANGELES CA
90011-3772
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-9686
  • Fax: 323-233-0595
Mailing address:
  • Phone: 323-233-9686
  • Fax: 323-233-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1085622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: