Healthcare Provider Details

I. General information

NPI: 1124558945
Provider Name (Legal Business Name): MRS. ADELINE PADURARU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 CITRUS CIR STE 240
WALNUT CREEK CA
94598-2667
US

IV. Provider business mailing address

3075 CITRUS CIR STE 240
WALNUT CREEK CA
94598-2667
US

V. Phone/Fax

Practice location:
  • Phone: 925-256-1100
  • Fax:
Mailing address:
  • Phone: 925-256-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-06530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: