Healthcare Provider Details

I. General information

NPI: 1356995880
Provider Name (Legal Business Name): LARAMID PADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14013 FAIRWAY ISLAND DR APT 435
ORLANDO FL
32837-5254
US

IV. Provider business mailing address

14013 FAIRWAY ISLAND DR APT 435
ORLANDO FL
32837-5254
US

V. Phone/Fax

Practice location:
  • Phone: 407-847-4152
  • Fax:
Mailing address:
  • Phone: 407-847-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: