MEDICARE: GRETEL L GALVAN-PADILLA RADT-1

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1417894486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETEL L GALVAN-PADILLA RADT-1

Provider Business Mailing Address
First Line	:	2100 SACRAMENTO ST
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94590-3126
Country	:	US
Telephone Number	:	707-642-8947
Fax Number	:	707-642-8949

Provider Business Practice Location Address
First Line	:	2100 SACRAMENTO ST
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94590-3126
Country	:	US
Telephone Number	:	707-642-8947
Fax Number	:	707-642-8949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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