Healthcare Provider Details

I. General information

NPI: 1245698497
Provider Name (Legal Business Name): KIMBERLY PADILLA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 716
SAN JUAN PR
00917-5030
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-294
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-3078
  • Fax: 787-767-7170
Mailing address:
  • Phone: 787-428-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21398
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number21398
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number21398
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: