Healthcare Provider Details

I. General information

NPI: 1417033994
Provider Name (Legal Business Name): ISMAEL PADILLA LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 408
LAS CRUCES NM
88011-8263
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 408
LAS CRUCES NM
88011-8263
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-7161
  • Fax: 575-522-3743
Mailing address:
  • Phone: 575-532-7161
  • Fax: 575-522-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number92-165
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: