Provider Demographics
NPI:1700183985
Name:PADILLA, ALEXANDER J (LSA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:PADILLA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 GLENFAIR CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3743
Mailing Address - Country:US
Mailing Address - Phone:713-426-3023
Mailing Address - Fax:
Practice Address - Street 1:9119 GLENFAIR CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3743
Practice Address - Country:US
Practice Address - Phone:713-426-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCSA-08108363AS0400X
DCSA-0130363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCSA0130OtherSTATE LICENCE