Healthcare Provider Details

I. General information

NPI: 1467175562
Provider Name (Legal Business Name): DR. JESUS A PADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 S DIXIE HWY
PINECREST FL
33156-1111
US

IV. Provider business mailing address

2288 NW 46TH ST
MIAMI FL
33142-4684
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-6840
  • Fax:
Mailing address:
  • Phone: 786-495-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: