Healthcare Provider Details

I. General information

NPI: 1982982245
Provider Name (Legal Business Name): RAMON R PADILLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 CAJA DEL ORO GRANT RD
SANTA FE NM
87507-3287
US

IV. Provider business mailing address

2361 CAJA DEL ORO GRANT RD
SANTA FE NM
87507-3287
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-6039
  • Fax: 505-473-5895
Mailing address:
  • Phone: 505-660-6039
  • Fax: 505-473-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number09341
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: