Provider Demographics
NPI:1528955408
Name:FUENTES PADILLA, EMANUEL (PA-S)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:FUENTES PADILLA
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:EMANUEL
Other - Middle Name:
Other - Last Name:BELTRAN PADILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2818 LOOP 250 FRONTAGE #A-308
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:214-532-7464
Mailing Address - Fax:
Practice Address - Street 1:3600 N GARFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6329
Practice Address - Country:US
Practice Address - Phone:214-532-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program