Provider Demographics
NPI:1902145139
Name:PADILLA, EDWARD PHILIP (MSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PHILIP
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W 154TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4013
Mailing Address - Country:US
Mailing Address - Phone:310-355-1958
Mailing Address - Fax:
Practice Address - Street 1:3133 W 154TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4013
Practice Address - Country:US
Practice Address - Phone:310-355-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS99031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical