Provider Demographics
NPI:1447444377
Name:PADILLA-OTTO, BERLINDA A (PA)
Entity type:Individual
Prefix:
First Name:BERLINDA
Middle Name:A
Last Name:PADILLA-OTTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:DIABETES SUPPORT SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-5598
Mailing Address - Fax:785-354-5396
Practice Address - Street 1:1500 SW 10TH AVE.
Practice Address - Street 2:DIABETES SUPPORT SERVICES
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-354-5598
Practice Address - Fax:785-354-5396
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01893363A00000X
OK1656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201135850AMedicaid
KS068002374OtherMEDICARE-PTAN
OK5390430012Medicare NSC
OK200123510AMedicaid