Healthcare Provider Details

I. General information

NPI: 1700183985
Provider Name (Legal Business Name): ALEXANDER J PADILLA LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 GLENFAIR CT
SPRING TX
77379-3743
US

IV. Provider business mailing address

9119 GLENFAIR CT
SPRING TX
77379-3743
US

V. Phone/Fax

Practice location:
  • Phone: 713-426-3023
  • Fax:
Mailing address:
  • Phone: 713-426-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberCSA-08108
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA-0130
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: