Healthcare Provider Details

I. General information

NPI: 1285310359
Provider Name (Legal Business Name): SAVANNAH MARIE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR STE 200
SANTA FE NM
87505-8608
US

IV. Provider business mailing address

UNM PA PROGRAM MSC 09 5040 1 UNM
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: