Provider Demographics
NPI:1043310550
Name:PADILLA ROSA, SAMUEL
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:PADILLA ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1096
Mailing Address - Country:US
Mailing Address - Phone:787-854-3851
Mailing Address - Fax:
Practice Address - Street 1:J23 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7930174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10209OtherACAA
PR1653OtherPREFERRED MEDICARE CHOISE
PR81764OtherTRIPLE SSS
PR7530053OtherHUMANA
PRPE2000OtherPALIC
PR825444OtherMMM
PR81764OtherBLUE CROSS & BLUE SHIELD
PR212407OtherPREFERRED HEALTH
PR437930OtherU.I.A.
PR660609707OtherMAPFRE
PR69646OtherCRUZ AZUL
PR1380OtherAMERICAN HEALTH MEDICARE
PRE27914OtherUPIN
PR10209OtherACAA