Provider Demographics
NPI:1124420377
Name:PADRIDIN, SELMMAN RICARDO
Entity type:Individual
Prefix:MR
First Name:SELMMAN
Middle Name:RICARDO
Last Name:PADRIDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 SE 7TH CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5868
Mailing Address - Country:US
Mailing Address - Phone:754-214-9122
Mailing Address - Fax:
Practice Address - Street 1:411 E 9TH ST
Practice Address - Street 2:BOX #12
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5036
Practice Address - Country:US
Practice Address - Phone:912-435-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25468079246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory