Healthcare Provider Details

I. General information

NPI: 1851961767
Provider Name (Legal Business Name): JOSHUA DANIEL PADILLA SUDCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 1ST ST
EUREKA CA
95501-0840
US

IV. Provider business mailing address

2950 JANES RD
ARCATA CA
95521-4721
US

V. Phone/Fax

Practice location:
  • Phone: 707-273-6395
  • Fax:
Mailing address:
  • Phone: 949-202-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: