Healthcare Provider Details

I. General information

NPI: 1679497572
Provider Name (Legal Business Name): BRYANNA PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 E GARRETT AVE
FRESNO CA
93725-1711
US

IV. Provider business mailing address

4724 E GARRETT AVE
FRESNO CA
93725-1711
US

V. Phone/Fax

Practice location:
  • Phone: 559-558-6563
  • Fax:
Mailing address:
  • Phone: 559-558-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberY8508354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: