Healthcare Provider Details

I. General information

NPI: 1083255475
Provider Name (Legal Business Name): NATTASHA I PADILLA NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VISTALAGO 56 CALLE LAGO CARRAIZO
GURABO PR
00778
US

IV. Provider business mailing address

HC 44 BOX 12540
CAYEY PR
00736-9702
US

V. Phone/Fax

Practice location:
  • Phone: 787-436-4892
  • Fax:
Mailing address:
  • Phone: 787-641-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8002
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14688
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: