Healthcare Provider Details

I. General information

NPI: 1336891720
Provider Name (Legal Business Name): ETHAN PADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 ESSEX AVE
TULARE CA
93274-1152
US

IV. Provider business mailing address

1500 S MOONEY BLVD
VISALIA CA
93277-4403
US

V. Phone/Fax

Practice location:
  • Phone: 951-441-0733
  • Fax:
Mailing address:
  • Phone: 800-207-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: