Healthcare Provider Details

I. General information

NPI: 1861958092
Provider Name (Legal Business Name): MARIA MAGDALENA PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12432 BELLFLOWER BLVD
DOWNEY CA
90242
US

IV. Provider business mailing address

1055 E COLORADO BLVD SUITE 560
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-295-3276
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41617
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: