Healthcare Provider Details

I. General information

NPI: 1174280515
Provider Name (Legal Business Name): HOPE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CLINTON ST
BALTIMORE MD
21224-5730
US

IV. Provider business mailing address

106 NIGHT HERON CT
CAMBRIDGE MD
21613-3658
US

V. Phone/Fax

Practice location:
  • Phone: 410-469-2323
  • Fax:
Mailing address:
  • Phone: 443-362-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR160272
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: