Provider Demographics
NPI:1316656176
Name:PADILLA MARTINEZ, LIANNETTE KARINA (MD)
Entity type:Individual
Prefix:
First Name:LIANNETTE
Middle Name:KARINA
Last Name:PADILLA MARTINEZ
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:DALIA 12
Mailing Address - Street 2:GARDENIAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5614
Mailing Address - Country:US
Mailing Address - Phone:787-509-3459
Mailing Address - Fax:
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5493
Practice Address - Country:US
Practice Address - Phone:718-250-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23056208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty