Healthcare Provider Details

I. General information

NPI: 1548733314
Provider Name (Legal Business Name): AMELIA PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HOEN AVE
SANTA ROSA CA
95405-9407
US

IV. Provider business mailing address

5263 BEAUMONT WAY
SANTA ROSA CA
95409-2861
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-0471
  • Fax:
Mailing address:
  • Phone: 951-235-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1244769
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: