Healthcare Provider Details

I. General information

NPI: 1780420984
Provider Name (Legal Business Name): JOSEPH RAUL PADILLA JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

IV. Provider business mailing address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 604-562-2618
  • Fax: 860-450-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13940
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: