Healthcare Provider Details

I. General information

NPI: 1770571416
Provider Name (Legal Business Name): JUAN M PADILLA MAIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/11/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 BABCOCK RD STE 106
SAN ANTONIO TX
78229-6009
US

IV. Provider business mailing address

2829 BABCOCK RD STE 106
SAN ANTONIO TX
78229-6009
US

V. Phone/Fax

Practice location:
  • Phone: 210-951-9055
  • Fax: 210-951-9066
Mailing address:
  • Phone: 102-951-9055
  • Fax: 956-630-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM8896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: