Provider Demographics
NPI:1033221189
Name:PADILLA, OSVALDO (MD)
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSVALDO
Other - Middle Name:
Other - Last Name:PADILLA-MONARREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 744127
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-4127
Mailing Address - Country:US
Mailing Address - Phone:915-577-7316
Mailing Address - Fax:915-577-7345
Practice Address - Street 1:2001 NORTH OREGON STREET
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-577-7316
Practice Address - Fax:915-577-7345
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226747207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W4710OtherBLUE CROSS BLUE SHIELD
TX8J3467Medicare PIN