Healthcare Provider Details

I. General information

NPI: 1225666951
Provider Name (Legal Business Name): RADIANT PATH PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 KING ST STE 5
WENATCHEE WA
98801-2857
US

IV. Provider business mailing address

330 KING ST STE 5
WENATCHEE WA
98801-2857
US

V. Phone/Fax

Practice location:
  • Phone: 509-797-7493
  • Fax: 833-913-2345
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RAUL ALEXANDER PADILLA
Title or Position: CEO
Credential: PMHNP-BC
Phone: 509-797-7493