Healthcare Provider Details

I. General information

NPI: 1740197557
Provider Name (Legal Business Name): EDWARD JAY PADILLA JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W LEGION RD
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

281 W LA PAZ DR
IMPERIAL CA
92251-8864
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3996
  • Fax: 760-351-3523
Mailing address:
  • Phone: 760-554-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License NumberRPH71315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: