=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144333048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HENRIETTA PADILLA MS, OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 LA JOLLA VILLAGE DR MAIL CODE 117B
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92161-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-552-8585
-----------------------------------------------------
Fax | 858-552-7459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9714 DRAGOYE DR
-----------------------------------------------------
City | SANTEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92071-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-518-5150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT 5484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------