Healthcare Provider Details

I. General information

NPI: 1679877682
Provider Name (Legal Business Name): JOSEPH PADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 CENTRAL AVE NW
ALBUQUERQUE NM
87105-2036
US

IV. Provider business mailing address

736 OMAHA ST NE
ALBUQUERQUE NM
87123-1770
US

V. Phone/Fax

Practice location:
  • Phone: 505-352-3405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: