MEDICARE: NATALIE GAYLE BADILLO CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	AP143195	TX

General Provider Information

NPI Number	:	1942810148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE GAYLE BADILLO CPNP-PC

Provider Business Mailing Address
First Line	:	3750 COMMERCIAL AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-3117
Country	:	US
Telephone Number	:	210-922-7000
Fax Number	:	210-681-9922

Provider Business Practice Location Address
First Line	:	9793 CULEBRA RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3750
Country	:	US
Telephone Number	:	210-223-3543
Fax Number	:	210-681-9922

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/06/2020

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