Healthcare Provider Details

I. General information

NPI: 1215991187
Provider Name (Legal Business Name): DORIS PADILLA-LONGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#64 GOYCO ST.
CAGUAS PR
00725-0000
US

IV. Provider business mailing address

PO BOX 6149
CAGUAS PR
00726-6149
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-2530
  • Fax: 787-746-2530
Mailing address:
  • Phone: 787-746-2530
  • Fax: 787-746-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7378
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: