Healthcare Provider Details

I. General information

NPI: 1891635751
Provider Name (Legal Business Name): TANIA D PADILLA BACALLAO RBT-26-520364
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NW JUANITA CT
CAPE CORAL FL
33993-1807
US

IV. Provider business mailing address

725 NW JUANITA CT
CAPE CORAL FL
33993-1807
US

V. Phone/Fax

Practice location:
  • Phone: 239-486-1083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-520364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: