Healthcare Provider Details

I. General information

NPI: 1962286948
Provider Name (Legal Business Name): CARLA JANET PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N PERRIS BLVD BLDG A
PERRIS CA
92571-2811
US

IV. Provider business mailing address

18612 MALKOHA ST
PERRIS CA
92570-6547
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5300
  • Fax:
Mailing address:
  • Phone: 951-500-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: