Provider Demographics
NPI:1730612862
Name:PADILLA, PATRISIA (CADC-CAS,C033490315)
Entity type:Individual
Prefix:
First Name:PATRISIA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:CADC-CAS,C033490315
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1460
Mailing Address - Country:US
Mailing Address - Phone:562-688-0735
Mailing Address - Fax:
Practice Address - Street 1:13931 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2941
Practice Address - Country:US
Practice Address - Phone:310-768-8018
Practice Address - Fax:310-768-4170
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADC-CAS,C033490315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)