Healthcare Provider Details

I. General information

NPI: 1265784144
Provider Name (Legal Business Name): PASCASIO L LOPEZ-PADILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 KELLY RD
ORLANDO FL
32831-2518
US

IV. Provider business mailing address

PO BOX 780165
ORLANDO FL
32878-0165
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-7332
  • Fax:
Mailing address:
  • Phone: 407-443-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberACN119
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number011694
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: