Healthcare Provider Details

I. General information

NPI: 1699658922
Provider Name (Legal Business Name): ALEXANDER ANGEL PADILLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16759 CHERRY TREE LN
FONTANA CA
92336-1867
US

IV. Provider business mailing address

16759 CHERRY TREE LN
FONTANA CA
92336-1867
US

V. Phone/Fax

Practice location:
  • Phone: 909-279-4380
  • Fax:
Mailing address:
  • Phone: 909-279-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number90260
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number90260
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License Number90260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: