Healthcare Provider Details

I. General information

NPI: 1184093007
Provider Name (Legal Business Name): CARLOS ANIBAL PADILLA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 W 131ST ST
LOS ANGELES CA
90061-1103
US

IV. Provider business mailing address

337 W 131ST ST
LOS ANGELES CA
90061-1103
US

V. Phone/Fax

Practice location:
  • Phone: 424-242-9374
  • Fax: 866-929-7421
Mailing address:
  • Phone: 424-242-9374
  • Fax: 866-929-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: