Healthcare Provider Details

I. General information

NPI: 1720240708
Provider Name (Legal Business Name): FERNANDO M PADILLA P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W 17TH ST 1
SANTA ANA CA
92706-3614
US

IV. Provider business mailing address

520 W 17TH ST 1
SANTA ANA CA
92706-3614
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-2727
  • Fax: 717-972-1193
Mailing address:
  • Phone: 714-972-2727
  • Fax: 717-972-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: