Provider Demographics
NPI:1043501208
Name:PADILLA, LEYBELIS (MD)
Entity type:Individual
Prefix:
First Name:LEYBELIS
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR DEPT OF
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5812
Mailing Address - Country:US
Mailing Address - Phone:619-532-8983
Mailing Address - Fax:619-532-9470
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5812
Practice Address - Country:US
Practice Address - Phone:619-532-8983
Practice Address - Fax:619-532-9470
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00698208M00000X, 207RG0100X
NC172895390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2806Medicaid
NC1043501208Medicaid
NCNC2806Medicaid
NCNCT162CMedicare PIN
NCNC2806Medicaid
NCNCT162BMedicare PIN
NCNCT162DMedicare PIN