Healthcare Provider Details

I. General information

NPI: 1003483280
Provider Name (Legal Business Name): MARTIN PADILLA CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 E TULARE AVE
TULARE CA
93274-3155
US

IV. Provider business mailing address

3330 S TERRACE CT
VISALIA CA
93277-7280
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-5839
  • Fax: 559-686-2470
Mailing address:
  • Phone: 559-300-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: