Provider Demographics
NPI:1366400434
Name:PADILLA-LOPEZ, JOSE VALENTIN (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:VALENTIN
Last Name:PADILLA-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12550 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-768-2111
Mailing Address - Fax:239-482-4404
Practice Address - Street 1:13650 METROPOLIS AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-768-2111
Practice Address - Fax:239-768-2113
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME60087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054789100Medicaid
FLF01844Medicare UPIN
FL12701Medicare ID - Type Unspecified