Healthcare Provider Details

I. General information

NPI: 1881558732
Provider Name (Legal Business Name): NATHALIE PAULINE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 N 28TH DR STE C202
PHOENIX AZ
85029-5600
US

IV. Provider business mailing address

44 W MONROE ST APT 2905
PHOENIX AZ
85003-4570
US

V. Phone/Fax

Practice location:
  • Phone: 623-383-5561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-489036
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: