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General NPI Number Information
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NPI Number | 1275948010
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Entity Type | Individual
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Provider Name | SERINA RENE PADILLA MD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2330 N KANSAS AVE
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City | LIBERAL
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State | KS
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Zip | 67901-2372
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Country | US
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Telephone | 620-624-0463
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 766
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City | GARDEN CITY
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State | KS
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Zip | 67846-0766
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Country | US
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Telephone | 620-271-7400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 04-39984
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License Number State | KS
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