Healthcare Provider Details

I. General information

NPI: 1912500802
Provider Name (Legal Business Name): ROBERTO ALFREDO PADILLA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6028 SURETY DR
EL PASO TX
79905-2018
US

IV. Provider business mailing address

2112 DUSK CREEK PL
EL PASO TX
79911-3133
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-3500
  • Fax:
Mailing address:
  • Phone: 915-383-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number61943
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1027095
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: