Yudaisy Mogena Padron, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PACN68 Issued in FL

Practice address

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548-3008

Phone

(813) 909-7102

Fax

(813) 909-0199

NPI assigned

Dec 7, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Myrtle Ridge Primary Care, P.a

  • General Practice Physician
  • Lutz, FL
  • NPI 1619504354

  Physician Assistant

  NPD Authorized official
• Myrtle Ridge Primary Care, P.a

  • Case Management Agency
  • Lutz, FL
  • NPI 1700553633
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1831800218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGENA PADRON",
        "first_name": "YUDAISY",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-07",
        "last_updated": "2025-07-16",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "2295PA",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PACN68",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "0105383",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA CERTIFICATION BOARD",
            "identifier": "CBHCMS0102580",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "PACN68",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116404300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PUERTO RICO MEDICAL DISCIPLINE AND LICENSUREE BOARD",
            "identifier": "2295PA",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA CERTIFICATION BOARD",
            "identifier": "CBHCM0105383",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1539 Dale Mabry Hwy Ste 102",
            "city": "Lutz",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335483008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kiele Miranda
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• Christian Monroe
• Eisel Montero Montes de Oca, APRN-C
• Marlon Montero
• Danieka Montgomery-Scott, FNP-BC
• Cameron Moody, MA, NCC

• Physician Assistant in Lutz, FL
• Providers in Lutz, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.