Provider Demographics
NPI:1336252063
Name:PADILLA-PAZ, LUIS ALFONSO (MD)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALFONSO
Last Name:PADILLA-PAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4610 JEFFERSON LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2117
Mailing Address - Country:US
Mailing Address - Phone:505-559-4495
Mailing Address - Fax:505-842-8025
Practice Address - Street 1:4610 JEFFERSON LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2117
Practice Address - Country:US
Practice Address - Phone:505-559-4495
Practice Address - Fax:505-842-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0087207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG78393Medicare UPIN
NM345607201Medicare PIN