Provider Demographics
NPI:1194969956
Name:WILLIAM J PADILLA A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WILLIAM J PADILLA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:619-422-1324
Mailing Address - Street 1:263 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2728
Mailing Address - Country:US
Mailing Address - Phone:619-422-1324
Mailing Address - Fax:619-422-1055
Practice Address - Street 1:263 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2728
Practice Address - Country:US
Practice Address - Phone:619-422-1324
Practice Address - Fax:619-422-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43091Medicare PIN