Healthcare Provider Details

I. General information

NPI: 1558912683
Provider Name (Legal Business Name): CARMEN D LLANOS PADILLA MA, CPT, B.HLTH.SCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 OLD BAY LN
KISSIMMEE FL
34743-6135
US

IV. Provider business mailing address

204 OLD BAY LN
KISSIMMEE FL
34743-6135
US

V. Phone/Fax

Practice location:
  • Phone: 407-434-9208
  • Fax:
Mailing address:
  • Phone: 407-434-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number640117190002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: