Healthcare Provider Details

I. General information

NPI: 1679504252
Provider Name (Legal Business Name): MARION J PADILLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 EAST PACIFIC COAST HIGHWAY STE. M
CORONA DEL MAR CA
92625
US

IV. Provider business mailing address

9452 GULSTRAND CIR
HUNTINGTON BEACH CA
92646-7903
US

V. Phone/Fax

Practice location:
  • Phone: 949-640-2121
  • Fax: 949-640-2631
Mailing address:
  • Phone: 714-962-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: