Healthcare Provider Details

I. General information

NPI: 1972506319
Provider Name (Legal Business Name): PAMELA A PADILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 W SAINT ISABEL ST STE B
TAMPA FL
33607-6355
US

IV. Provider business mailing address

2502 W SAINT ISABEL ST STE B
TAMPA FL
33607-6355
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-7106
  • Fax: 813-348-0074
Mailing address:
  • Phone: 813-873-7106
  • Fax: 813-348-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0037398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: