Healthcare Provider Details

I. General information

NPI: 1962451724
Provider Name (Legal Business Name): SAMUEL PADILLA MACHUCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/11/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 BAYAMON MEDICAL PLAZA STE 509
BAYAMON PR
00960
US

IV. Provider business mailing address

REPARTO TERESITA C/30 AD-3
BAYAMON RI
00961-8343
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-9200
  • Fax: 787-786-9700
Mailing address:
  • Phone: 787-466-3403
  • Fax: 787-268-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number15949
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: