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General NPI Number Information
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NPI Number | 1912568684
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Entity Type | Individual
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Provider Name | MARIAN PADILLA
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 05/11/2024
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Provider Practice Location Address
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Address Line | 1524 S INTERSTATE 35 STE 202
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City | AUSTIN
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State | TX
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Zip | 78704-2671
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Country | US
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Telephone | 512-707-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 513 PECAN GROVE RD APT 203
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City | AUSTIN
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State | TX
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Zip | 78704-2539
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Country | US
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Telephone | 360-927-2896
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17957
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA58090
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA58090
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License Number State | CA
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