Healthcare Provider Details

I. General information

NPI: 1184672610
Provider Name (Legal Business Name): IVONNE PADILLA AQUINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM SEPTIMA SECCION LEVITTOWN
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

VILLAS DE LA PLAYA CALLE BOQUERON #25
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2911
  • Fax: 787-784-0680
Mailing address:
  • Phone: 787-795-2911
  • Fax: 787-784-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11336
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: