Healthcare Provider Details

I. General information

NPI: 1467918946
Provider Name (Legal Business Name): EDGAR PADILLA-VALDIVIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 N CEDAR AVE
FRESNO CA
93726-1065
US

IV. Provider business mailing address

4770 N CEDAR AVE
FRESNO CA
93726-1065
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: