Healthcare Provider Details

I. General information

NPI: 1740744002
Provider Name (Legal Business Name): MRS. EUNICE MARIE PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 189 KM 3.1
GURABO PR
00778
US

IV. Provider business mailing address

PO BOX 51222
TOA BAJA PR
00950-1222
US

V. Phone/Fax

Practice location:
  • Phone: 787-363-5103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6255
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: