Healthcare Provider Details

I. General information

NPI: 1275948010
Provider Name (Legal Business Name): SERINA RENE PADILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N KANSAS AVE
LIBERAL KS
67901-2372
US

IV. Provider business mailing address

PO BOX 766
GARDEN CITY KS
67846-0766
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-0463
  • Fax:
Mailing address:
  • Phone: 620-271-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-39984
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: