MEDICARE: IVONNE PADILLA AQUINO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11336	PR

General Provider Information

NPI Number	:	1184672610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONNE PADILLA AQUINO M.D.

Provider Business Mailing Address
First Line	:	VILLAS DE LA PLAYA
Second Line	:	CALLE BOQUERON #25
City	:	VEGA BAJA
State	:	PR
Zip	:	00693
Country	:	US
Telephone Number	:	787-795-2911
Fax Number	:	787-784-0680

Provider Business Practice Location Address
First Line	:	HF16 CALLE LIZZIE GRAHAM
Second Line	:	SEPTIMA SECCION LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3634
Country	:	US
Telephone Number	:	787-795-2911
Fax Number	:	787-784-0680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/28/2012

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