Provider Demographics
NPI:1104264373
Name:PADURA, MA ANA LAGON (RPT)
Entity type:Individual
Prefix:MRS
First Name:MA ANA
Middle Name:LAGON
Last Name:PADURA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MA ANA
Other - Middle Name:TAPIZ
Other - Last Name:LAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4021 N PINE ISLAND RD
Mailing Address - Street 2:APARTMENT 404
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6520
Mailing Address - Country:US
Mailing Address - Phone:954-470-5818
Mailing Address - Fax:
Practice Address - Street 1:4021 N PINE ISLAND RD
Practice Address - Street 2:APARTMENT 404
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6520
Practice Address - Country:US
Practice Address - Phone:954-470-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist