Healthcare Provider Details

I. General information

NPI: 1538881511
Provider Name (Legal Business Name): ALEXANDER LAWRENCE PADILLA-HARROLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 11TH ST
TRACY CA
95376-3944
US

IV. Provider business mailing address

8534 DON AVE
STOCKTON CA
95209-2306
US

V. Phone/Fax

Practice location:
  • Phone: 209-831-5941
  • Fax:
Mailing address:
  • Phone: 707-718-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: