Healthcare Provider Details

I. General information

NPI: 1043145204
Provider Name (Legal Business Name): ADRIANA IVELISSE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 805 KM 4.2
COROZAL PR
00783
US

IV. Provider business mailing address

HC 6 BOX 12445
COROZAL PR
00783-7803
US

V. Phone/Fax

Practice location:
  • Phone: 787-648-1165
  • Fax:
Mailing address:
  • Phone: 787-648-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5844
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: