Basic Information
Provider Information
NPI: 1417451592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PADILLA
FirstName: RICARDO
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 N STATE ST
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900891001
CountryCode: US
TelephoneNumber: 3234097053
FaxNumber:  
Practice Location
Address1: 1200 N STATE ST.
Address2: CLINIC TOWER, SUITE A7D
City: LOS ANGELES
State: CA
PostalCode: 900331029
CountryCode: US
TelephoneNumber: 3234091000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/22/2018
LastUpdateDate: 07/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XA166164CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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