Healthcare Provider Details

I. General information

NPI: 1366354417
Provider Name (Legal Business Name): KAIRI JEDZIAH PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 ROBERTS VILLAGE CT STE 1301
SAINT JOHNS FL
32259-9582
US

IV. Provider business mailing address

8649 A C SKINNER PKWY APT 1211
JACKSONVILLE FL
32256-7888
US

V. Phone/Fax

Practice location:
  • Phone: 904-701-2112
  • Fax: 904-789-5759
Mailing address:
  • Phone: 904-701-2112
  • Fax: 904-789-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-2840877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: