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NPI Code Detail

MEDICARE: MS. ELIZABETH MICHELLE PADILLA

MEDICARE: MS. ELIZABETH MICHELLE PADILLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist29197CA

General Provider Information

NPI Number : 1083850903
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH MICHELLE PADILLA
Provider Business Mailing Address
First Line : 14239 E SHAVER ST
Second Line :
City : LA PUENTE
State : CA
Zip : 91746-1729
Country : US
Telephone Number : 626-734-8555
Fax Number :
Provider Business Practice Location Address
First Line : 1300 CLAY ST STE 600
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1427
Country : US
Telephone Number : 626-734-8555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2008
Last Update Date : 08/11/2025

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