Provider Demographics
NPI:1215991187
Name:PADILLA-LONGO, DORIS (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:PADILLA-LONGO
Suffix:
Gender:F
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:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6149
Mailing Address - Country:US
Mailing Address - Phone:787-746-2530
Mailing Address - Fax:787-746-2530
Practice Address - Street 1:#64 GOYCO ST.
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-746-2530
Practice Address - Fax:787-746-2530
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40352Medicare UPIN
PRFIO73ZMedicare PIN