Provider Demographics
NPI:1265784144
Name:LOPEZ-PADILLA, PASCASIO L (MD)
Entity type:Individual
Prefix:
First Name:PASCASIO
Middle Name:L
Last Name:LOPEZ-PADILLA
Suffix:
Gender:M
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:PO BOX 780165
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-0165
Mailing Address - Country:US
Mailing Address - Phone:407-443-7317
Mailing Address - Fax:
Practice Address - Street 1:7000 KELLY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32831-2518
Practice Address - Country:US
Practice Address - Phone:407-207-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN119207QA0505X
PR011694207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine