Healthcare Provider Details

I. General information

NPI: 1023525078
Provider Name (Legal Business Name): MISS CAROLINA CHRISTINE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 RICHMOND AVE STE 5
STATEN ISLAND NY
10314-3923
US

IV. Provider business mailing address

10910 CAMERON CT APT 101
DAVIE FL
33324-4165
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax:
Mailing address:
  • Phone: 786-405-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42022
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: