Healthcare Provider Details

I. General information

NPI: 1033312541
Provider Name (Legal Business Name): DOMINGA SOL PADILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N RTE 17 SUITE 302
PARAMUS NJ
07652-2809
US

IV. Provider business mailing address

PO BOX 746
RIDGEWOOD NJ
07451-0746
US

V. Phone/Fax

Practice location:
  • Phone: 201-689-1939
  • Fax: 201-689-0204
Mailing address:
  • Phone: 201-689-1939
  • Fax: 201-689-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07800500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: