Provider Demographics
NPI:1972694792
Name:PADILLA, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9772207Q00000X
CAA43091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430910Medicaid
A85853Medicare UPIN
CAA43091Medicare ID - Type Unspecified