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General NPI Number Information
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NPI Number | 1609956119
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Entity Type | Individual
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Provider Name | JORGE PADILLA PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 3600 WASHINGTON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8216
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Country | US
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Telephone | 954-518-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 92 NW 100TH TER
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City | MIAMI SHORES
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State | FL
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Zip | 33150-1208
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Country | US
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Telephone | 305-756-8523
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 9102841
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License Number State | FL
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