Provider Demographics
NPI:1194091173
Name:PADILLA, JIMMY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:STEVEN
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 N EDGEMONT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5260
Mailing Address - Country:US
Mailing Address - Phone:323-783-6621
Mailing Address - Fax:323-783-1029
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-6621
Practice Address - Fax:323-783-1029
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128916208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation